Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

Sang Woo Kim; Chae Chil Lee; Sang Hun Ko; Il Yeong Hwang; Min Seok Kim; Woo Young Jin

doi:10.12671/jkfs.2019.32.1.1

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Original Article Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures: Sang Woo Kim, Chae Chil Lee, Sang Hun Ko, Il Yeong Hwang, Min Seok Kim, Woo Young Jin; Journal of Musculoskeletal Trauma 2019;32(1):1-5.
DOI: https://doi.org/10.12671/jkfs.2019.32.1.1
Published online: January 31, 2019

Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. lunarticguy@naver.com

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Abstract

PURPOSE
This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.
MATERIALS AND METHODS
Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.
RESULTS
The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100Â°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.
CONCLUSION
DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

Keywords: Proximal phalanx, Phalangeal pilon fracture, Distraction dynamic external fixator, Kirschner wires

J Korean Fract Soc. 2019 Jan;32(1):1-5. Korean.
Published online Jan 25, 2019.
https://doi.org/10.12671/jkfs.2019.32.1.1

Original Article

Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

Sang Woo Kim

, M.D., Chae Chil Lee

, M.D., Sang-Hun Ko

, M.D., Il-Yeong Hwang

, M.D., Min-Seok Kim

, M.D. and Woo Young Jin

, M.D.

Author information

Author notes

- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Correspondence to: Chae Chil Lee, M.D. Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea. Tel: +82-52-250-7129, Fax: +82-52-235-2823, Email: lunarticguy@naver.com

Received August 31, 2017; Revised May 30, 2018; Accepted September 28, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.

Materials and Methods

Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.

Results

The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.

Conclusion

DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

Keywords

Proximal phalanx, Phalangeal pilon fracture, Distraction dynamic external fixator, Kirschner wires

Figures

Fig. 1
Close-up X-ray image of the subluxation of proximal interphalangeal joint and suspected injury to the ulnar collateral ligament.

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Fig. 2
Close-up X-ray image of distraction dynamic external fixator applied to subluxation of the proximal interphalangeal joint.

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Fig. 3
Medical photograph of a patient who applied distraction dynamic external fixator at 3 days after operation.

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Fig. 4
Medical photograph of a patient who applied distraction dynamic external fixator. Range of motion exercise was encouraged 3 to 5 days after surgery.

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Fig. 5
Medical photograph of a patient applied distraction dynamic external fixator at 5 weeks after operation.

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Fig. 6
Medical photograph of a patient applied distraction dynamic external fixator. The external fixator was removed after 5 weeks.

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Tables

Table 1
Demographics and Summary of the Results

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Notes

Financial support:None.

Conflict of interests:None.

References

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report
Yongun Cho, Jai Hyung Park, Se-Jin Park, Ingyu Lee, Eugene Kim
Journal of the Korean Fracture Society.2019; 32(4): 222. CrossRef

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Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

J Korean Fract Soc. 2019;32(1):1-5. Published online January 31, 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.1.1