Case Report: Bridge Plating for Unstable PIP Fracture Dislocation

Document Type : CASE REPORT

Authors

1 Department of Orthopaedics, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

2 Department of Orthopedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA

Abstract

Proximal interphalangeal (PIP) fracture-dislocation is a relatively common injury that results from “jamming” a finger.
Treatment hinges on the degree of articular surface involvement, which determines stability of the joint. For unstable
injuries, a variety of surgical interventions have been described including extension block pinning, open reduction internal
fixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. We present the
case of an unstable, subacute ring finger PIP dorsal fracture dislocation for which the above options were not possible or
desirable to the patient.
We performed temporary bridge plate fixation of the joint, based on the success of a similar procedure used to treat
comminuted and unstable distal radius fractures.
The procedure allowed immediate return to work, which was the patients’ primary goal, and resulted in a reasonable shortterm
outcome, similar to other mentioned procedures.
Temporary bridge plate fixation can be considered among treatment choices for PIP fracture dislocation when other, more
established options are not possible or desirable.
Level of evidence: IV

Keywords

References

1. Hastings 2nd H, Carroll CT. Treatment of closed
articular fractures of the metacarpophalangeal and
proximal interphalangeal joints. Hand Clinics. 1988;
4(3):503.
2. Gonzalez RM, Hammert WC. Dorsal fracturedislocations
of the proximal interphalangeal joint.
Journal of Hand Surgery. 2015; 40(12):2453-5.
3. Waris E, Mattila S, Sillat T, Karjalainen T. Extension
block pinning for unstable proximal interphalangeal
joint dorsal fracture dislocations. The Journal of Hand
Surgery. 2016; 41(2):196-202.
4. Haseth KB, Neuhaus V, Mudgal CS. Dorsal fracturedislocations
of the proximal interphalangeal joint:
evaluation of closed reduction and percutaneous
Kirschner wire pinning. Hand. 2015; 10(1):88-93.
5. Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ. Dorsal
fracture dislocations of the proximal interphalangeal
joint: surgical complications and long-term results.
The Journal of hand surgery. 1999; 24(5):914-23.
6. Ruland RT, Hogan CJ, Cannon DL, Slade JF. Use of
dynamic distraction external fixation for unstable
fracture-dislocations of the proximal interphalangeal
joint. The Journal of hand surgery. 2008; 33(1):19-25.
7. Lauder A, Agnew S, Bakri K, Allan CH, Hanel DP, Huang
JI. Functional outcomes following bridge plate fixation
for distal radius fractures. The Journal of hand surgery.
2015; 40(8):1554-62.
8. Unglaub F, Langer MF, Hahn P, Müller LP, Ahrens C,
Spies CK. Fractures of the proximal interphalangeal
joint: Diagnostic and operative therapy options. Der
Unfallchirurg. 2016; 119(2):133-43.
9. Hamer DW, Quinton DN. Dorsal fracture subluxation
of the proximal interphalangeal joints treated by
extension block splintage. Journal of Hand Surgery.
1992; 17(5):586-90.
10. Inanami H, Ninomiya S, Okutsu I, Tarui T, Fujiwara N.
Dynamic external finger fixator for fracture dislocation
of the proximal interphalangeal joint. The Journal of
hand surgery. 1993; 18(1):160-4.
11. Krakauer JD, Stern PJ. Hinged device for fractures
involving the proximal interphalangeal joint. Clinical
Orthopaedics and Related Research (1976-2007).
1996; 327:29-37.
12. Nilsson JA, Rosberg HE. Treatment of proximal
interphalangeal joint fractures by the pins and rubbers
traction system: a follow-up. Journal of plastic surgery
and hand surgery. 201448(4):259-64.
13. Kubitskiy A, Soliman BA, Dowd MB, Curtin P. External
fixation of the hand: a simple approach to comminuted
proximal interphalangeal joint fractures. Hand Surgery.
2014; 19(01):85-9.
14. Frueh FS, Calcagni M, Lindenblatt N. The hemi-hamate
autograft arthroplasty in proximal interphalangeal
joint reconstruction: a systematic review. Journal of
Hand Surgery (European Volume). 2015; 40(1):24-32.
The Archives of Bone and Joint Surgery
Volume 8, Issue 6
November and December 2020
Pages 739-743

Files

History

  • Receive Date: 22 August 2019
  • Revise Date: 23 January 2020
  • Accept Date: 25 January 2020

Share

How to cite

Statistics