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Open Reduction and Internal Fixation for Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint Using a Miniplate

Ikeda, Masayoshi MD, PhD*; Kobayashi, Yuka MD, PhD; Saito, Ikuo MD, PhD; Ishii, Takayuki MD; Shimizu, Ayuko MD; Oka, Yoshinori MD, PhD*

Techniques in Hand & Upper Extremity Surgery: December 2011 - Volume 15 - Issue 4 - p 219–224
doi: 10.1097/BTH.0b013e3182190712

Various operative techniques have been described for unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint with articular involvement. However, this injury still remains a therapeutic challenge for hand surgeons because no single technique guarantees successful outcomes. We performed a novel procedure using a low-profile miniplate, which allows for anatomic reduction, rigid internal fixation, and early finger joint motion. Between March 2003 and May 2009, 18 consecutive patients who suffered from 19 dorsal fracture dislocations of the PIP joint with volar articular fracture of the middle phalanx involving more than 40% of the articular surface were treated using this technique. The postoperative follow-up period averaged 16.6 months (range, 12-18 mo). Bony union was obtained in all cases. No patient showed residual dorsal subluxation. Active motion of the PIP joint averaged 85.0 degrees (range, 62-105 degrees), flexion contracture averaged 5.4 degrees (range, 0-17 degrees), and percent total active interphalangeal joint motion averaged 89.0% (range, 60%-100%). Two patients had restricted active distal interphalangeal joint flexion owing to tendon adhesion resulting from the use of a relatively long plate in the first few cases of this series. No major complications were reported for the other 16 patients. We describe the surgical technique, indications, complications, and postoperative management for this technique.

*Department of Orthopaedic Surgery, Tokai University Oiso Hospital

Department of Orthopaedics, Tokai University School of Medicine, Kanagawa

Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Tokyo, Japan

Conflicts of Interest: The authors report no conficts of interest.

Address correspondence and reprint requests to: Masayoshi Ikeda, MD, PhD, Department of Orthopaedic Surgery, Tokai University Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-gun, Kanagawa 259-0198, Japan. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.