Dynamic external fixation for PIP fracture-...
Transcript of Dynamic external fixation for PIP fracture-...
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Dynamic external fixation for PIP fracture- dislocations
Eleni BalabanidouSpecialty Doctor in Trauma and
Orthopaedics
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Complex problem
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• Splinting• Open reduction &internal fixation• K-wire stabilisation• External fixation
1. Static2. Dynamic
• Fusion• Arthroplasty• Replacement
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Dynamic external fixation
• Easy• Quick• Not affecting fracture site
(ligamentotaxis)• Immediate mobilisation
(enhance cartilage and joint remodelling)• Cheap
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Indications
• Unstable fractures of base of middle phalanx• Unstable dislocations of PIP joint• Flexion deformity of PIP joint (?)• In combination with ORIF
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Contra-indications
• Sepsis• Bone loss• Condylar fracture of P1• Previous neurovascular repair• (Collateral ligament injury)
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Technique
• Local anaesthesia• No tourniquet• X-ray• two or three 1.4mm K-wires
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How I do it
• Compliant patient• Local anaesthesia• Confirm that joint is reducable• Insertion of wires• Bending of wires and formation of frame
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How I do it
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Radiographs
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The third K-wire
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Immediate mobilisation
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Technique
• No incisions- no dressings• Chiro clips• Keeping finger dry• X-ray check in 2 weeks• X-ray check in 4 weeks and removal of frame
in clinic
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Complications
• Loss of reduction• Pin site infection• Stiffness
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“Homemade” vs commercial
• Minimum cost• Minimum invasion• Minimum problems• Right indications
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• Bain GI, Mehta JA, Heptinstall RJ et al. Dynamic External Fixation for injuries of the Proximal Interphalangeal Joint. JBJS 80B: 1014-1019,1998
• Curtis M. Henn, Steve K. L, Scott W Wolfe “Dynamic External Fixation for Proximal Interphalangeal Fracture-Dislocations”, Operative Techniques in Orthopaedics09/2012; 22(3):142–150. DOI: 10.1053/j.oto.2012.04.002
• Krakauer JD, Stern PJ. Hinged device for fractures involving the proximal interphalangeal joint. Clin Orthop Relat Res. 1996 Jun;(327):29-37.
• Richter M, Brüser P. Long-term follow-up of fracture dislocations and comminuted fractures of the PIP joint treated with Suzuki's pin and rubber traction system. Handchir Mikrochir Plast Chir. 2008 Oct;40(5):330-5. doi: 10.1055/s-2008-1038450. Epub 2008 Jul 16. German.
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• Ruland RT, Hogan CJ, Cannon DL, Slade JF. Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2008 Jan;33(1):19-25. doi: 10.1016/j.jhsa.2007.07.018
• Schenck RR. Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint. J Hand Surg Am. 1986 Nov;11(6):850-8.
• Suzuki Y, Matasunaga T, Sato S et al. The pins and Rubber Traction System for treatment of Comminuted Intraarticular Fractures and Fracture- Dislocations in the Hand. JBJS 19B:98- 107, 1994
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Thank you