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Volar plating of dorsal PIPJ fracture-dislocations
BMC Proceedings volume 9, Article number: A47 (2015)
Fracture-dislocations of the proximal interphalangeal joint (PIPJ) remains a challenging injury to manage. For those that are unstable, a variety of surgical treatment have been reported, each with its pros and cons:
Open reduction and internal fixation, with
Interfragmentary screws from either the dorsal or volar approach,
Hemi-hamate osteochondral grafting, using fixed with interfragmentary screws,
Volar plating of dorsal fracture-dislocation of the PIPJ with mini-T or hook plates ensures secure fixation and allows early mobilization with good results. This technique is also applicable when the volar fragment is comminuted.
The surgical technique of volar plating with mini-C arm guidance is as follows:
exposure through A3 pulley
mobilization of volar fragment attached to volar plate
dorsal blocking wire to reduce and hold joint in place
elevation of any depressed articular fragment and bone grafting
repositioning of volar fragment over the base of middle phalanx
preliminary fixation with K wire
plating with mini 1.2 or 1.3mm T plate, or hook plate(s)
removal of dorsal block wire if stable
Early range of motion exercise regime is started. A resting gutter splint is applied to prevent flexion contracture of the PIPJ.
Chew WYC, Cheah AEJ: Volar plate and screw fixation for dorsal fracture-dislocation of the proximal interphalangeal joint: case report. J Hand Surg. 2010, 35 (6): 928-930. 10.1016/j.jhsa.2010.02.011.
Cheah AE, Tan DM, Chong AK, Chew WY: Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg Am. 2012, 37 (1): 28-33.
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Chong, W.C.Y. Volar plating of dorsal PIPJ fracture-dislocations. BMC Proc 9, A47 (2015). https://doi.org/10.1186/1753-6561-9-S3-A47
- Flexion Contracture
- Interphalangeal Joint
- Exercise Regime
- Motion Exercise
- Middle Phalanx