Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint.

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of -6° and -9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and -5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating.Level of evidence: IV.