Callus release and dynamic external fixation for delayed presentation of proximal interphalangeal joint fracture-dislocations

Abstract

Various treatments have been proposed for fracturedislocations of the proximal interphalangeal (PIP) joint. Among them, dynamic distraction external fixation (DDEF) has become an attractive and favourable surgical intervention for hand surgeons because it allows early active motion and is less invasive to the surrounding soft tissues (Abou Elatta et al., 2017). However, it would appear to be impractical to use DDEF alone if the fracture-dislocation of the PIP joint has progressed to a delayed stage with partial healing and malunion at the fracture site. Therefore, we present a method of DDEF with preliminary percutaneous callus release to manage delayed presentation fracture-dislocations of the PIP joint. Between January 2017 and February 2019, three patients with fracture-dislocations of the PIP joint were treated in this manner at the senior author’s hospital. The delay in treatment was longer than 4 weeks from injury, when we considered that early union was underway with unsatisfactory restoration of the articular surface. All fractures involved less than 50% of the base of the middle phalanx. We excluded patients with a fracture pattern hindering the application of DDEF, stiff fingers without any passive range of motion, infection, and severe medical conditions hindering the patient’s survival. All the surgeries were performed by the senior corresponding author (experience Level III – experienced