Use of Dynamic Distraction External Fixation for Unstable Fracture-Dislocations of the Proximal Interphalangeal Joint

Robert T. Ruland, Christopher J. Hogan, David Cannon, Joseph F. Slade

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Purpose: Unstable fracture-dislocations of the proximal interphalangeal (PIP) joint remain a difficult management problem, often leading to residual pain, stiffness, and recurrent instability. In a military setting, an easily applied, simple to operate, and inexpensive device becomes an attractive option. The purpose of this clinical investigation was to retrospectively review use of dynamic distraction external fixation (DDEF) for unstable fracture-dislocations and pilon injuries of the PIP joint in an active-duty population. Methods: The fixator is assembled under a local anesthetic from three 1.4-mm (0.045-inch) K-wires and rubber bands. It uses the principles of a lever and ligamentotaxis to assist and maintain reduction. Thirty-four members of the Armed Services, 27 men and 7 women (average age, 30 y), had DDEF for pilon fractures and unstable fracture-dislocations of the PIP joint. A retrospective review of these individuals was conducted. Final range of motion was determined from the clinical records at the final visit. Results: There were 26 PIP fracture-dislocations (3 chronic, average 6 weeks) and 8 PIP pilon injuries. The average follow-up period was 16 months (range, 6-84 months). The final arc of motion at the PIP joint averaged 88°, and the average distal interphalangeal joint arc of motion was 60°. Eight patients experienced superficial pin-track infections that were easily controlled with oral antibiotics. There were no cases of septic arthritis or osteomyelitis requiring intravenous antibiotics or premature fixator removal. Loss of reduction did not occur. All patients returned to their prior level of activity and duties. Conclusions: Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. Easily applied and simple to operate, DDEF is a valuable addition to the hand surgeon's armamentarium. We recommend its use for both primary and adjunctive treatment of acute and chronic unstable PIP joint fracture-dislocations and for primary treatment of PIP pilon injuries. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish (US)
Pages (from-to)19-25
Number of pages7
JournalJournal of Hand Surgery
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2008

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Joints
Joint Dislocations
Wounds and Injuries
Anti-Bacterial Agents
Fracture Fixation
Infectious Arthritis
Rubber
Osteomyelitis
Articular Range of Motion
Local Anesthetics
Fracture Dislocation
Therapeutics
Hand
Pain
Equipment and Supplies
Infection
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Use of Dynamic Distraction External Fixation for Unstable Fracture-Dislocations of the Proximal Interphalangeal Joint. / Ruland, Robert T.; Hogan, Christopher J.; Cannon, David; Slade, Joseph F.

In: Journal of Hand Surgery, Vol. 33, No. 1, 01.01.2008, p. 19-25.

Research output: Contribution to journalArticle

Ruland, Robert T. ; Hogan, Christopher J. ; Cannon, David ; Slade, Joseph F. / Use of Dynamic Distraction External Fixation for Unstable Fracture-Dislocations of the Proximal Interphalangeal Joint. In: Journal of Hand Surgery. 2008 ; Vol. 33, No. 1. pp. 19-25.
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