Outcomes of Static External Fixation in Delayed Presentations of Dorsal PIPJ Subluxation.

Background

Neglected dorsal subluxation of the proximal interphalangeal joint (PIPJ) results in significant compromise of hand function. Operations like volar plate arthroplasty, hemihamate arthroplasty and joint fusions have been described to treat them. However, all are open procedures and technically demanding. Dynamic external fixation has been used as a treatment for acute injuries. There is a paucity of literature on the use of static external fixation in the treatment of neglected PIPJ fracture subluxations. We describe the outcomes of the use of static external fixation followed by splinting and therapy for this injury.

Methods

Six adults who had chronic dorsal subluxations of the PIPJ with a minimum chronicity of 5 weeks from the injury were included in the study. All of them underwent application of joint-spanning external fixation followed by acute single-step intraoperative distraction. The apparatus was removed at 5 weeks, followed by splinting and therapy. Outcomes recorded were pain scores, total active motion (TAM) and Quick DASH score.

Results

The mean age of patients was 30 years. The mean time from injury to surgery was 4.2 months. The mean preoperative VAS was 3.66, and the postoperative VAS was 1.83. The mean TAM improved from 131.6° to 253°. The mean Q-DASH score was 6.41.

Conclusions

Static PIPJ distraction using an external fixator followed by splinting and therapy gives good results in neglected dorsal PIPJ fracture subluxations. Level of Evidence: Level IV (Therapeutic).