Chulalongkorn Medical Journal


Background : Fractures of the phalanx account for more than 20% of all upper extremitiesfracture, mostly, proximal phalanx (P1) fracture. Managing periarticularfracture of P1 has remained a challenging problem for hand surgeonespecially comminuted fracture. Several operative techniques wereperformed to gain anatomical reduction, stable fixation and early range ofmotion. We proposed a novel technique: adjacent interdigital pinning.Objective : The aims of this study were determined the outcome of periarticular baseof P1 fractures performed by the surgical procrdure, namely: adjacentinterdigital pinning technique.Methods : A periarticular base of P1 fracture was reduced by distal traction. The earlyjoint exercise was allowed because both metacarpophalangeal (MCP) andproximal interphalangeal (PIP) remained free of motion. The two or threepins were inserted into the proximal phalanx of injured digit to the proximalphalanx of nearby digit after the fracture was reduced. Fluoroscopy wasused to check alignment and reduction. Range of motion (ROM) exercisestrated immediately after the operation.Results : Three patients with periarticular P1 fractures were recruited. The averagefollow-up period was 3 months. The mean ROM of the injured MCP ofthose 3 patients was 83. The mean ROM of PIP was 80. The patientsreported visual analogue pain score of 0 - 1 after 3 months of operation.The grip strength was at least 80% compared to uninjured side. All caseswere union within 4 weeks without serious complication. The angulation offracture sites were not more than 10 degree in coronal and sagittal view.Conclusion : Adjacent interdigital pinning is economical, easy for application andprovides good results; thus, it should be an alternative way to manageperiarticular P1 fracture.


Faculty of Medicine, Chulalongkorn University

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