Modern aspects in the treatment of intra-articular fractures and fractures of the proximal interphalangeal joints of the three-phalangeal fingers of the hand, as well as their consequences

Abstract

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the finger’s function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both “acute” and long-standing injuries, each with advantages and disadvantages.

OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).

MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.

RESULTS: The patient estimated the VAS pain syndrome at 4–6 points on the scale; however, after 6–8 weeks, this indicator was 0–1 points. After 6–8 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 30–50° after 6–8 weeks, was reached the average of 15–95°. There was a 15–20° extensor contracture in two patients.

CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.

Keywords

hemihamate / proximal interphalangeal joint / fracture dislocation / Suzuki / pins and rubber traction system / intra-articular fractures

References

[1] Korshunov VF, Magdiev DA, Barsuk VI. Udlinenie kul’tej pal’cev kisti i ustranenie ukorochenij falang i pyastnyh kostej. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2004;(1):66–70. (In Russ).

[2] Коршунов В.Ф., Магдиев Д.А., Барсук В.И. Удлинение культей пальцев кисти и устранение укорочений фаланг и пястных костей // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2004. № 1. C. 66–70.

[3] Gil’mutdinova LT, Kutliahmetov NS, Sahabutdinova AR. Medicinskaya reabilitaciya bol’nyh s travmami verhnih konechnostej. Fundamental’nye issledovaniya. 2014;10(4):647–650. (In Russ).

[4] Гильмутдинова Л.Т., Кутлиахметов Н.С., Сахабутдинова А.Р. Медицинская реабилитация больных с травмами верхних конечностей // Фундаментальные исследования. 2014. Т. 10, № 4. C. 647–650.

[5] Korshunov VF, Magdiev DA, Barsuk VI. Stabil’nyj intramedullyarnyj osteosintez pri perelomah pyastnyh kostej i falang pal’cev kisti. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2000;(2):22–26. (In Russ). doi: 10.17816/vto101596

[6] Коршунов В.Ф., Магдиев Д.А., Барсук В.И. Стабильный интрамедуллярный остеосинтез при переломах пястных костей и фаланг пальцев кисти // Вестник травматологии и ортопедии им. Н.Н.Приорова. 2000. № 2. C. 22–26. doi: 10.17816/vto101596

[7] Caggiano NM, Harper CM, Rozental TD. Management of Proximal Interphalangeal Joint Fracture Dislocations. Hand Clinics. 2018;34(2):149–165. doi: 10.1016/j.hcl.2017.12.005

[8] Caggiano N.M., Harper C.M., Rozental T.D. Management of Proximal Interphalangeal Joint Fracture Dislocations // Hand Clinics. 2018. Vol. 34, № 2. Р. 149–165. doi: 10.1016/j.hcl.2017.12.005

[9] Jha P, Bell D, Hacking C. Keifhaber-Stern classification of volar plate avulsion injuries of hand. Radiopaedia.org [cited 2023 Sep 26]. Available from: https://radiopaedia.org/articles/47255

[10] Jha P., Bell D., Hacking C. Keifhaber-Stern classification of volar plate avulsion injuries of hand // Radiopaedia.org. Дата обращения: 26.09.2023. Доступ по ссылке: https://radiopaedia.org/articles/47255

[11] Jha P, Weerakkody Y, Hacking C, et al. Eaton classification of volar plate avulsion injury. Radiopaedia.org [cited 2023 Sep 26]. Available from: doi: 10.53347/rID-47254

[12] Jha P., Weerakkody Y., Hacking C., et al. Eaton classification of volar plate avulsion injury // Radiopaedia.org. Дата обращения: 26.09.2023. Доступ по ссылке: doi: 10.53347/rID-47254

[13] Lo CH, Nothdurft SH, Park H-S, Paul E, Leong J. Distraction ligamentotaxis for complex proximal interphalangeal joint fracture dislocations: a clinical study and the modified pins rubber band traction system revisited. Burns Trauma. 2018;6:23. doi: 10.1186/s41038-018-0124-1

[14] Lo C.H., Nothdurft S.H., Park H.-S., Paul E., Leong J. Distraction ligamentotaxis for complex proximal interphalangeal joint fracture dislocations: a clinical study and the modified pins rubber band traction system revisited // Burns Trauma. 2018. Vol. 6. Р. 23. doi: 10.1186/s41038-018-0124-1

[15] Suzuki Y, Matsunaga T, Sato S, Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand. Journal of Hand Surgery (British and European Volume). 1994;19(1):98–107. doi: 10.1016/0266-7681(94)90059-0

[16] Suzuki Y., Matsunaga T., Sato S., Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand // Journal of Hand Surgery (British and European Volume). 1994. Vol. 19, № 1. Р. 98–107. doi: 10.1016/0266-7681(94)90059-0

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