Different kinds of surgical procedures are applied to treat the unstable fracture-dislocations of PIPJ. As the fracture is considered unstable, many investigators have recommended the management of these fractures via surgical interventions since nonsurgical treatment usually results in malunion, joint stiffness, or joint subluxation ( 9). If a PIP fracture is grossly displaced, the joint is subluxated or the articular damage of the base of the middle phalanx is over 40% or over 30-degree flexion of the joint is needed to obtain a congruent and non-subluxated joint. Nondisplaced or minimally displaced fractures with congruent joint and less than 40% involvement of articular surface of base of middle phalanx without subluxation are considered to be stable and are amenable to healing by various fashions of splinting ( 8). Nonsurgical management is used for stable fractures. The outcome of these injuries depends on the amount of articular surface of the base of the middle phalanx and the maintenance of a congruent reduction of the joint with the most respect to adjacent soft tissues ( 7).Įvaluation of stability is the most essential step to plan for the treatment of PIPJ fracture-dislocations. Significant finger stiffness, loss of function, and residual pain are the most disabling complications of PIPJ fracture-dislocations ( 6). Type 4 is an extraarticular fracture, and type 5 occurs on the sagittal plane. In type 3, also named as PIPJ pilon fracture, both volar and dorsal buttresses are involved, and the central part is usually depressed, which is usually associated with the worst outcome. In types 1 and 2, the fracture is on the palmar and dorsal sides, respectively. If any disruption occurs in these elements, whether as a rupture or as a bony avulsion, subluxation or dislocation of the joint are not inevitable and may occur in volar, dorsal, or lateral direction, while dorsal dislocation is the most common type of PIPJ dislocation ( 4).įracture-dislocation of the PIPJ is considered a prevalent injury, classified by Seno et al. The PIPJ is a hinge joint normally stabilized by a complex of soft tissues, including collateral ligaments, volar plate, and central extensor slip. Therefore, it can be stated that PIPJ is the anatomical and functional locus of finger function ( 3). In comparison with other hand joints, PIPJ has the greatest arc of motion and is responsible for up to 85% of the total encompassment during grasp ( 2). Proximal interphalangeal joint (PIPJ) of the fingers plays an undeniable role in the function of hands ( 1).
0 kommentar(er)
