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Dynamic Traction with Open Reduction Internal Fixation for Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint
Kun Liu, MD, Hand surgery department, Beijing Jishuitan Hospital, Beijing, China

Objective
To investigate the outcome of dynamic traction with open reduction internal fixation (ORIF) for treatment of fracture-dislocations of the proximal interphalangeal(PIP) joint.

Methods
From July 2013 to January 2016, 10 consecutive patients diagnosed with fracture-dislocations of the PIP joint were treated with dynamic traction with ORIF either with K-wires or mini-screws. Among all patients 8 were male and femal 2. The age range of patients was 18 to 56 years(average 32, y). One index finger, 2 long fingers and 7 ring were involved. Four injuries were related to sports(football 3, skating 1), 3 related to fight, and 3 to work. Of all the patients, 8 were comminuted. Articular involvement ranged from 40% to 68% (average, 54%). The average time to surgery was 4 days (range, 1-9 d). All fractures was reduced and fixed with K-wires or mini-screws through a volar "shot-gun" approach. Autogeneous bone graft was performed in one patient and allogeneic bone graft in two. After closure of the incision the dynamic external fixator was applied and was removed at 5-6 weeks postoperatively. The clinical and radiological outcomes were measured.

Results
All patients had follow-up of 3 to 29 months (average, 12 mo). No infection, allograft bone rejection or pin loosening occurred. Eight fractures united in good alignment and no joint subluxation occurred, 2 patients showed degenerative changes and had a supplementary surgery. Average grip strength was 86% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 97° and 68°, respectively. The average Visual Analogue Scale (VAS) Pain Score was 0.3. Average Quick Disabilities of Arm, Shoulder, and Hand (Quick DASH) score was 4 (range, 0-8). All patients returned to their original occupation and all were satisfied with the result.

Conclusions
Dynamic traction with ORIF with K-wire or mini-screw is a technique required method for fracturedislocations of the PIP joint. It allows early active movement of the PIP joint and provides good objective and subjective outcomes.


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