RESEARCH ARTICLE


Mid-Term Outcomes After Open Reduction Internal Fixation of Proximal Interphalangeal Joint Dorsal Fracture-Dislocations Through a Volar, Shotgun Approach and a Review of the Literature



Juan Marcelo Giugale1, *, Juntian Wang2, Robert A. Kaufmann3, John R. Fowler4
1 Orthopaedic Surgery Resident Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
2 Medical Student University of Pittsburgh - School of Medicine Pittsburgh, PA, USA
3 Associate Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
4 Assistant Dean for Medical Student Research Assistant Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA


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© 2017 Giugale et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Orthopaedic Surgery Resident Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA 15213, Tel: 412-9604469, Fax: 412-6873724; E-mail: fowlerjr@upmc.edu


Abstract

Background:

Proximal interphalangeal (PIP) fracture dislocations remain a complex injury pattern to treat. There are several treatment methods available aimed to restore stability, preserve range of motion, and reconstitute the articular surface. This study looked at the mid-term clinical and radiographic results of open reduction internal fixation through a shotgun approach of comminuted PIP fracture dislocations.

Methods:

A retrospective review was conducted of all PIP fracture dislocations treated through a volar, shotgun approach at a single institution over a 15-year period. Patients identified were contacted and asked to return to the office for clinical and radiographic evaluation. Patient reported outcomes were assessed with the Michigan hand questionnaire (MHQ) and visual analog scale (VAS) for pain.

Results:

5 patients returned to the office for further evaluation with average follow-up of 69 months (range, 33-133 months). 3 patients were found to have post traumatic arthritis on radiographs. 1 case had recurrent instability and one case had a deep infection, both necessitating further surgical intervention. Average PIP arc of motion was found to be 79°. Average VAS score of 0 and MHQ result of 95 (out of a possible score of 100) indicating no residual pain and excellent functionality of the affected hand.

Conclusion:

Open reduction internal fixation of comminuted PIP fracture dislocations utilizing the volar, shotgun approach provides excellent mid-term functional results despite the high incidence of post traumatic arthritis.

Keywords: Proximal Interphalangeal (PIP) Fracture, PIP dislocation, Open reduction internal fixation, Shotgun Volar Approach, Long term outcome, Review of Treatment Options.