Transplantationstechnologien und Forschung

Pilon Fractures of Middle Phalanx Managed with Lag Screw and Early Mobilisation

Abstract

Chandan Jadhav N

Background: Injury following proximal interphalangeal joint fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered. The degree of stability is directly determined by the amount of middle phalangeal volar lip involvement and the degree of commination of the base of the middle phalanx.
Methods: Case series of five patients who presented between Jan to June 2015 with pilon fracture of the middle phalanx. Mechanism of injury was axial loading onto to the proximal interphalangeal joint, while playing Australian football. All of them presented within 3 days of their initial injury with fracture of the volar lip of base of middle phalanx with dorsal subluxation along with commination of the base of middle phalanx appreciated on CT scan. All of them underwent open reduction via the shot gun approach and fixation with 1.3 mm lag screw. Also bone graft from the Lister`s tubercle of distal radius was used to realign the joint congruity in cases with severe comminution.
Results: Post operatively they underwent early mobilisation within the volar plate protocol and good outcome in terms of proximal interphalangeal joint function and stability.
Conclusion: Early intervention in the form of open reduction and internal fixation with or without bone graft in cases of pilon fractures restores the joint congruity and helps in achieving good functional outcome.