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

Article information

J Musculoskelet Trauma. 2019;32(1):1-5

Publication date (electronic) : 2019 January 10

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

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., Woo Young Jin, M.D.

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 E-mail: lunarticguy@naver.com

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

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 intraarticular 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^o), 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

Fig. 1.

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

Fig. 2.

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

Fig. 3.

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

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.

Fig. 5.

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

Fig. 6.

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

Table 1.

Demographics and Summary of the Results

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