Proposal of a New Dynamic Distraction Device to Treat ComplexPeriarticular Fractures of the Metacarpophalangeal Joint of LongFinger

摘要

Background: Complex periarticular fractures of themetacarpophalangeal joint (MCPJ) are often challenging to treat. Conservativeand operative treatments are often burdened with stiffness, loss of function,and poor clinical outcome. These phenomena could be a direct consequence of longperiod of immobilization. To promote a short time of immobilization and a quickreturn to daily activities, it is mandatory to stabilize the fracturemaintaining the active range of motion (AROM) of the ray. A simple solution isto reduce the fragments by means of dynamic ligamentotaxis. The authors proposea new dynamic distraction device (DDD) for the MCPJ. Methods: TheDDD for the MCPJ was made of Kirschner wires bent and connected to counteractdislocation forces and to allow mobilization of the joint. The DDD was tested ona cadaver model under a simulated load in physiological conditions, and also inmetacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of thedevice was evaluated under fluoroscopy. Results: The data showedthat DDD is able to achieve fracture reduction through ligamentotaxis andprimary fragments stability and to avoid secondary dislocation during AROM ofcomplex periarticular fractures of the MCPJ. Conclusions: The framecould be an alternative option to treat periarticular fractures of the MCPJ. TheDDD implant has several advantages: It is time efficient because assembly andapplication take only few minutes. Furthermore, it is very versatile; indeed, itcan be used in all metacarpal and phalanx bones, even in the central rays.