Fijación con mini-tornillo para el tratamiento de la fractura-luxación…(I)

Stephen C. Hamilton BA, a, , Peter J. Stern MDa, Paul R. Fassler MDa and Thomas R. Kiefhaber MDa aDepartment of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH; and Hand Surgery Specialists Inc., Cincinnati, OH. Received 10 January 2006; accepted 24 July 2006. Available online 10 October 2006. Purpose Surgical intervention may be necessary to treat unstable dorsal fracture–dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture–dislocations of the PIP joint using mini-screws via a volar approach. Methods A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture–dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws. Results A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70° (range, 55°–90°). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85°, and the average PIP joint motion for the remaining 7 patients was 65°. One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14°. Seven patients had no pain, and 2 had pain only with heavy activity. Conclusions Open reduction and internal fixation of unstable dorsal PIP joint fracture–dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture.