Surgical Management of Proximal Interphalangeal Joint Fracture-Dislocations: A Review of Outcomes

The Hand Pub Date : 2019-09-13 DOI:10.1177/1558944719873152

Cory Demino, M. Yates, J. Fowler

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引用次数: 10

Abstract

Background: Treatment of proximal interphalangeal joint (PIPJ) fracture-dislocations is difficult given the potential long-term complications of the involved finger and entire hand. Several surgical methods have been utilized for management of these injuries, none of which have shown consistently favorable results. The purpose of this systematic review of the literature is to report the post-operative outcomes of multiple treatment modalities for PIPJ fracture-dislocations in various studies. Methods: A literature review of PubMed and EMBASE databases was performed for all articles on PIPJ fracture-dislocations. Outcomes of interest included PIPJ range of motion, grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, hand (QuickDASH). Articles were distributed into 5 groups by surgical method: open reduction, percutaneous fixation, dynamic external fixation, extension-block pinning, and hemi-hamate arthroplasty. Results: Forty-eight of 1679 total screened articles were included. The weighted means of post-operative range of motion (ROM; degrees) at final follow-up were open reduction 84.7 (n = 146), percutaneous fixation 86.5 (n = 32), dynamic external fixation 81.7 (n = 389), extension-block pinning 83.6 (n = 85), and hemi-hamate arthroplasty 79.3 (n = 52). Dorsal fracture-dislocations, regardless of surgical method, had an average ROM of 83.2 (n = 321), grip strength 91% (n = 132), and QuickDASH of 6.6 (n = 59) while pilon injuries had an average ROM of 80.2 (n = 48), grip strength 100% (n = 13), and QuickDASH of 11.4 (n = 13). Conclusion: Percutaneous fixation yielded the highest post-operative ROM at final follow-up while extension-block pinning resulted in the greatest grip strength. While dorsal fracture-dislocations produced higher average ROM and lower QuickDASH score, pilon fractures produced a higher grip strength. No treatment method or fracture type yielded consistently better outcomes than another.

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近端指间关节骨折脱位的外科治疗:结果综述

背景:近端指间关节(PIPJ)骨折脱位的治疗是困难的，因为受累的手指和整个手的潜在的长期并发症。已有几种外科方法用于治疗这些损伤，但没有一种方法显示出一贯的良好效果。本系统文献综述的目的是报道各种研究中PIPJ骨折脱位的多种治疗方式的术后结果。方法:对PubMed和EMBASE数据库中有关PIPJ骨折脱位的所有文章进行文献回顾。感兴趣的结果包括PIPJ运动范围，握力(对侧手的百分比)和手臂，肩膀，手的快速残疾(QuickDASH)。采用切开复位、经皮内固定、动态外固定、延伸块钉钉、半钩骨关节置换术将物品分为5组。结果:共筛选1679篇文章，纳入48篇。术后关节活动度(ROM;最终随访时，切开复位84.7度(n = 146)，经皮内固定86.5度(n = 32)，动态外固定81.7度(n = 389)，延伸块钉钉83.6度(n = 85)，半钩骨关节置换术79.3度(n = 52)。无论采用何种手术方法，背部骨折脱位的平均ROM为83.2 (n = 321)，握力91% (n = 132)， QuickDASH为6.6 (n = 59)，而腰肢损伤的平均ROM为80.2 (n = 48)，握力100% (n = 13)， QuickDASH为11.4 (n = 13)。结论:经皮内固定在最后随访时获得了最高的术后ROM，而伸展块钉钉获得了最大的握力。背侧骨折脱位会产生较高的平均ROM和较低的QuickDASH评分，而枕部骨折会产生较高的握力。没有一种治疗方法或骨折类型的疗效优于其他治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Hand

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