Staged External Fixation for Chronic Fracture-Dislocation of the Proximal Interphalangeal Joint: Outcomes of Patients With a Minimum 2-Year Follow-Up

Purpose To introduce a new surgical strategy for chronic fracture-dislocations of the proximal interphalangeal (PIP) joint with 2-staged external fixation. We also assessed the results of this method in all of our patients with at least 2 years of follow-up. Methods We used the procedure in 6 cases. For the first step, we applied mini external fixators for 1 week before surgery to apply traction to the PIP joint with sufficient force to stretch the dislocated joint components. The second procedure was surgical release of the PIP joint and an attempt at percutaneous reduction and fixation. This was not possible in 4 cases, and we performed an open reduction and corrective osteotomy. Postoperative early rehabilitation was achieved under controlled movement using an external fixator that allowed PIP joint flexion and extension. Results At long-term follow-up (mean, 3.5 y), the range of movement of PIP joints had increased by 76 degrees, and that of distal interphalangeal joints by 35 degrees. Osteochondral remodeling likely occurred not only while the joint was protected with the dynamic external fixator during a 12-week period (range, 8-14 wk), but also after removal. Conclusions Preoperative traction softens the PIP joint, facilitating both surgery and rehabilitation. Postoperative early exercise with controlled movement, while maintaining concentric reduction with the external fixator, may accelerate osteochondral repair of the injured PIP joint. (J Hand Surg 2012;37A:434-439. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.