The Treatment of Interphalangeal Joint Fracture Dislocations with the Pin and Rubber Method

Abstract

Aim: This study aimed to evaluate the clinical and radiological results of interphalangeal joint injuries treated with the pin-and-rubber method and to determine the effectiveness of this treatment method. Material and Method: Patients aged 18 years or older who presented with injuries of the interphalangeal joints of the hand and were treated with the pin-and-rubber method were included in the study. Patients with open fractures, multiple finger injuries, or those who underwent open surgery were excluded. Total of 32 interphalangeal joint injuries were evaluated retrospectively. Eight of those patients declined to participate in the study and the final analysis included 24 fingers of a total of 24 patients. Age, sex, injured finger, type of injury, and time until treatment were recorded for all patients. Union was evaluated based on joint radiographs from patients final follow-up appointments. For the evaluation of functional results, joint range of motion was measured with a finger goniometer and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and visual analog scale (VAS) scores were evaluated. Results: The median age of the analyzed patients was 30 (18-69) years. The most frequent mechanism of injury was fall (52.4%) and the most frequent injured finger was the fourth. The median follow-up duration for these patients was 25 (16.25-31.75) months. The median DASH score was 4.16 (0.00-7.50) and the median VAS score was 4 (0.00-8.00). The median range of motion of the proximal interphalangeal joint was 90° (80.00-98.75°), while that of the distal interphalangeal joint was 55° (36.25-80.00°). Union was achieved in all cases. Condylar fractures were observed in two patients over the course of follow-up. Conclusion: The treatment of interphalangeal joint fractures or fracture dislocations by the pin-and-rubber method was confirmed to be an easily applicable and effective treatment method that does not cause a significant loss range of motion.

Keywords

• Finger fracture
• hand surgery
• pin and rubber

References

1. Agee JM. Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique. J Hand Surg Am. 1978;3:386-9.
2. Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years' experience. J Hand Surg Am. 1980;5:260-8.
3. Lee JY, Teoh LC. Dorsal fracture dislocations of the proximal interphalangeal joint treated by open reduction and interfragmentary screw fixation: indications, approaches and results. J Hand Surg Br. 2006;31:138-46.
4. Singh T, Jayawardhana R, Craigen M, Rajaratnam V. Volar buttress plating for unstable dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Microsurg. 2019;11:106-10.
5. Caggiano NM, Harper CM, Rozental TD. Management of proximal interphalangeal joint fracture dislocations. Hand Clin. 2018;34:149-65.
6. Agee JM. Unstable fracture dislocations of the proximal interphalangeal joint. Treatment with the force couple splint. Clin Orthop Relat Res. 1987:101-12.
7. Gonzalez RM, Hammert WC. Dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2015;40:2453-5.
8. Agee J. Treatment principles for proximal and middle phalangeal fractures. Orthop Clin North Am. 1992;23:35-40.

9. Stern PJ, Roman RJ, Kiefhaber TR, McDonough JJ. Pilon fractures of the proximal interphalangeal joint. J Hand Surg Am. 1991;16:844-50.
10. Breahna A, Mishra A, Arrowsmith J, Lindau T. The management of acute fracture dislocations of proximal interphalangeal joints: a systematic review. J Plast Surg Hand Surg. 2020;54:323-7.
11. Aladin A, Davis TR. Dorsal fracture-dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation. J Hand Surg Br. 2005;30:120-8.
12. Demino C, Yates M, Fowler JR. Surgical management of proximal interphalangeal joint fracture-dislocations: a review of outcomes. Hand (N Y). 2021;16:453-60.
13. van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br. 2003;28:491-5.
14. Kneser U, Goldberg E, Polykandriotis E, et al. Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations. Arch Orthop Trauma Surg. 2009;129:29-37.
15. Allison DM. Fractures of the base of the middle phalanx treated by a dynamic external fixation device. J Hand Surg Br. 1996;21:305-10.
16. De Smet L, Boone P. Treatment of fracture-dislocation of the proximal interphalangeal joint using the Suzuki external fixator. J Orthop Trauma. 2002;16:668-71.
17. Keramidas E, Solomos M, Page RE, Miller G. The Suzuki frame for complex intra-articular fractures of the proximal interphalangeal joint of the fingers. Ann Plast Surg. 2007;58:484-8.
18. Debus G, Courvoisier A, Wimsey S, et al. Pins and rubber traction system for intra-articular proximal interphalangeal joint fractures revisited. J Hand Surg Eur Vol. 2010;35:396-401.
19. Agarwal AK, Karri V, Pickford MA. Avoiding pitfalls of the pins and rubbers traction technique for fractures of the proximal interphalangeal joint. Ann Plast Surg. 2007;58:489-95.
20. Ellis SJ, Cheng R, Prokopis P, et al. Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg Am. 2007;32:1242-50.
21. Finsen V. Suzuki's pins and rubber traction for fractures of the base of the middle phalanx. J Plast Surg Hand Surg. 2010;44:209-13.
22. Gianakos A, Yingling J, Athens CM, et al. Treatment for acute proximal interphalangeal joint fractures and fracture-dislocations: a systematic review of the literature. J Hand Microsurg. 2020;12:S9-15.
23. Abou Elatta MM, Assal F, Basheer HM, et al. The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Eur Vol. 2017;42:182-7.
24. Kiral A, Erken HY, Akmaz I, et al. Pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand. J Hand Surg Am. 2014;39:696-705.
25. Mabvuure NT, Pinto-Lopes R, Sierakowski A. Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device. Arch Orthop Trauma Surg. 2020;140:1133-41.
26. de Soras X, de Mourgues P, Guinard D, Moutet F. Pins and rubbers traction system. J Hand Surg Br. 1997;22:730-5.