Miniature plates and screws can be used to provide fixation for unstable proximal interphalangeal joint dorsal fracture dislocations — but at the risk of complications, according to researchers in Singapore.
The researchers performed a retrospective review of 13 consecutive dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint that had been treated with miniature volar plate and screw fixation, according to the study abstract. With patients ranging in age from 15 years to 56 years, the researchers reported six comminuted fractures among the 13 DFDs and an average time to surgery of 7 days. Follow-up averaged 25 months.
Plate and screw removal complicated postoperative courses for four patients, the authors reported, and the incidents occurred at an average of 4 months postoperatively as part of a secondary procedure or by patient request. All patients in the study returned to work and 11 patients reported to be satisfied with the procedure and 12 patients reported no pain or mild pain.
The 13 DFDs were reported to have united in proper alignment, although the authors noted that three DFDs “showed degenerative changes.” Grip strength averaged 85% of the unaffected side, with average PIP joint and distal interphalangeal joint motion arcs measuring 75° and 65°, respectively.
“This treatment allows early active range of motion and provides good objective and subjective outcomes,” the authors wrote. “However, noteworthy complications occurred in 39% of patients.”