Intramedullary Percutaneous Fixation of Extra-Articular Proximal and Middle Phalanx Fractures

摘要

Multiple methods have been described for treating unstable proximal and middle phalangeal fractures. Irrespective of using an open or closed technique of fixation, stiffness and extensor lag at the proximal/distal interphalangeal joint almost always occur. This issue can be avoided by allowing the patients to mobilize the fingers out of plaster or splint as early as possible from the day of surgery. We describe a technique of intramedullary percutaneous fixation of extra-articular proximal and middle phalanx fractures allowing immediate mobilization of fingers, concurrent stabilization with progressive healing and thus preventing such complications. Various techniques have been described for fixation of proximal and middle phalangeal fractures. Proximal and middle phalanges are surrounded circumferentially by gliding tissue around which is of paramount importance to achieve good range of movements in the postoperative period (Fig. 1). Closed techniques with K-wires require immobilization and open techniques are heralded by adhesions of extensor mechanism resulting in stiffness at proximal interphalangeal joint (PIPJ), extensor lag, and limited range of motion. Because of unpredictable nature of outcome they are often called "troublesome" and since they coincide with the zone 2 flexor territory they are "no man's land" of hand fractures. Another concern about the method of fixation in open, but clean fracture of proximal phalanx (Chow type 1) 25% of which are expected to have poor outcome. Recently, del Pinal et al, described minimally invasive fixation of phalangeal and metacarpal fractures with intramedullary cannulated headless screws.