Arthroscopy in Intra-articular Fractures of the Base of the Proximal Phalanx of the Hand.

Abstract

Intra-articular fractures of the base of the proximal phalanx tend to have a significant functional impact in the metacarpophalangeal joint since the articular congruency and gliding motion of the tendons are compromised, with some degree of postoperative stiffness, limited range of motion and pain. We describe a case series of 12 patients who attended our institution, diagnosed with an intra-articular fracture of the base of the proximal phalanx. They underwent surgery for reduction and internal fixation with screws, miniplates and/or Kirschner wires, with an arthroscopic evaluation of the articular surface. In the postoperative follow-up, we evaluated functional outcomes, mobility range, stiffness and recovery time needed to return to daily activities. The functional and clinical outcomes in patients with arthroscopic assistance were satisfactory and allowed them to return promptly to their daily activities without any limitations, with no evidence of articular damage and minimum postoperative pain. The evaluation of the articular surface with a small arthroscopic lens allows the surgeon to visualize possible step-offs and gaps that were not evident in the fluoroscopic examination, with proper placement of osteosynthesis material, using either Kirschner wires or screws through conventional minimally invasive approaches. Even though arthroscopic skills usually tend to go through a learning curve, this method is an alternative and complementary procedure for providing a healing environment for early postoperative mobilization. Alignment and stability preserve the gliding motion of the tendons, which allows an early active range of motion.