Treatment of dorsal fracture-dislocations of the proximal interphalangeal joint using the shotgun approach.

UNLABELLED: This study assessed the outcome of open reduction and internal fixation of proximal interphalangeal joint fracture-dislocations through a shotgun approach, while keeping hemi-hamate arthroplasty as a back-up plan. After using the shotgun approach, fixation was carried out when the anterior fragment was large enough to accept two 1.5 mm screws. Sixty-three fracture-dislocations were treated in 61 patients, of whom 30 underwent internal fixation. Twenty-one of these were assessed in the final study. At a mean follow-up of 29 months, the mean range of joint motion was 80° and 102° for the injured and contralateral hand, respectively. The mean pinch and grip strengths of injured hand were 82% and 83% of contralateral hand, respectively. The mean disabilities of the arm, shoulder and hand score was 5.5. The mean visual analogue pain score was 1.6. Surgery through the versatile shotgun approach allows excellent intra-operative assessment and acceptable outcomes.

LEVEL OF EVIDENCE: IV.