Department of Orthopaedics, Saiseikai Shiga Hospital, Ritto, Shiga, Japan.
Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan.
J Hand Surg Asian Pac Vol. 2024 Aug;29(4):286-293. doi: 10.1142/S2424835524500280. Epub 2024 Jul 12.
Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20-81 years). The fracture patterns were volar-type ( = 2), dorsal-type ( = 4) and pilon-type ( = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. The levels of articular involvement were stable ( = 1), tenuous ( = 5) and unstable ( = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°-106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°-90°). Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level IV (Therapeutic).
近节指间关节（PIPJ）关节内骨折如果治疗不当，可能会导致不良后果。动态外固定和钢板/螺钉内固定是两种治疗选择。联合使用这两种方法的作用尚不清楚。本研究旨在确定使用钢板/螺钉联合动力外固定治疗 PIPJ 关节内骨折患者的治疗结果。
对 18 例 PIPJ 关节内骨折患者采用克氏针和橡皮条牵引系统（PRTS）联合背侧钢板/螺钉内固定进行回顾性分析。患者平均年龄为 51 岁（范围：20-81 岁）。骨折类型为掌侧型（=2）、背侧型（=4）和 Pilon 型（=12）。收集手术时间、指间关节活动范围、握力、疼痛视觉模拟评分（VAS）、快速残疾指数（Quick DASH）评分、并发症、随访时间和重返工作时间等数据。关节面受累程度稳定（=1）、脆弱（=5）和不稳定（=12）。平均手术时间为 9 天，平均随访时间为 15 个月。10 例患者采用背侧钢板和螺钉固定，8 例患者仅采用螺钉固定。所有患者均使用 PRTS。所有患者均恢复到原来的职业，骨折愈合良好。平均握力为健侧的 86%。平均主动 PIPJ 活动度为 85°（范围：50°-106°），平均主动远侧指间关节（DIPJ）活动度为 48°（范围：10°-90°）。
我们的结果表明，PRTS 联合切开复位钢板/螺钉内固定可获得良好的活动度和关节复位。
四级（治疗）。
