Bhat Anil K, Pai Gurpur Mithun, Panarukandy Navaneeth
Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
J Hand Surg Am. 2025 Sep;50(9):1125.e1-1125.e9. doi: 10.1016/j.jhsa.2024.08.010. Epub 2024 Oct 7.
Fracture-dislocations of the proximal interphalangeal (PIP) joint are difficult to manage. In the case of a 2- to 4-week delay in definitive treatment, a nascent malunion may result. This study aimed to evaluate the effectiveness of the percutaneous triple K-wire technique for treatment of the PIP joint nascent malunion.
We treated 13 patients with nascent malunion of PIP joint fracture-dislocations using the percutaneous triple K-wire fixation technique based on the principle of soft callus manipulation to achieve congruity and reduction in the joint. The study included cases where the percentage of articular involvement exceeded 40% and in whom there was a minimum follow-up of 12 months. At the final follow-up, we measured the range of motion at the PIP joint. The Ishida and Ikuta scores were determined.
The mean period between injury and surgery was 17.2 days. The average follow-up time was 14.2 months. The mean active arc of motion before surgery in the PIP joint was 15 degrees and that at the final follow-up was 83 degrees. Seven patients achieved excellent outcomes according to the Ishida and Ikuta scores. The final postoperative range of motion at the PIP joint was comparable with that reported in the literature for patients who underwent different procedures.
This procedure can be considered a viable alternative to open reduction and plating, hemihamate arthroplasty, and ligamentotaxis with distraction, particularly in the presence of nascent malunion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
近端指间（PIP）关节骨折脱位难以处理。在确定性治疗延迟2至4周的情况下，可能会出现早期骨不连。本研究旨在评估经皮三枚克氏针技术治疗PIP关节早期骨不连的有效性。
我们采用经皮三枚克氏针固定技术治疗13例PIP关节骨折脱位早期骨不连患者，该技术基于软骨痂操作原理，以实现关节的一致性和复位。研究纳入关节面受累超过40%且至少随访12个月的病例。在最后一次随访时，我们测量了PIP关节的活动范围。确定了石田和生田评分。
受伤至手术的平均时间为17.2天。平均随访时间为14.2个月。PIP关节术前平均主动活动弧度为15度，最后一次随访时为83度。根据石田和生田评分，7例患者取得了优异的结果。PIP关节术后最终活动范围与文献报道的接受不同手术的患者相当。
该手术可被视为切开复位钢板内固定、半钩骨成形术和牵引下韧带整复术的可行替代方案，尤其是在存在早期骨不连的情况下。
研究类型/证据水平：治疗性IV级。
