A Percutaneous Technique to Treat Unstable Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joint

Purpose Unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint are complex injuries that are difficult to treat and usually require operative fixation. There are a number of surgical techniques for treating these injuries but none has emerged as superior. The purposes of this study were to describe a simple percutaneous technique to treat unstable dorsal fracture-dislocations of the PIP joint and to report short-term postoperative results. Methods We treated 6 patients with unstable dorsal fracture-dislocations of the PIP joint with the technique of closed reduction, percutaneous fracture reduction, and pinning via a volar approach and also with dorsal block pinning. We collected information on postoperative stability, range of motion at the PIP and distal interphalangeal joints, and radiographic outcomes. We also administered the Disabilities of the Arm, Shoulder, and Hand and visual analog pain scale questionnaires. Results At a mean follow-up of 18 months (range, 6-57 mo), there were no subluxation or dislocation events. The mean range of motion was from 4 degrees of extension to 93 degrees of flexion at the PIP joint and from 1 degrees of extension to 73 degrees of flexion at the distal interphalangeal joint. Radiographic analysis revealed a concentric reduction and union in all cases. The mean Disabilities of the Arm, Shoulder, and Hand score was 8 and the mean visual analog pain score was 1.4 out of 10. There were no minor or major complications. Conclusions This percutaneous technique reliably restored stability to the PIP joint, allowed for concentric reduction of the joint, and produced excellent radiographic and clinical outcomes. The postoperative management course with this technique is critical to the outcome. (J Hand Surg 2011;36A:1453-1459. Copyright (C) 2011 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.