PIP Dorsal Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 28 лип 2024
- Dr. Ebraheim’s educational animated video describes the PIP dorsal fracture dislocation
Proximal interphalangeal (PIP) dorsal fracture dislocation can be challenging in management. With PIP dorsal fracture dislocation, there is involvement of the articular surfaces of the joint. These injuries are the most disabling PIP joint injuries (fellowship level). Reduction of the middle phalanx on the condyles of the proximal phalanx is the primary goal of treatment. The patient frequently presents with a chronic dorsal subluxation due to delay in seeking treatment or from failed treatment.
Anatomy: 85% of motion from grasping objects occurs at the PIP joint. The PIP joint has the largest arc of motion (120 degrees ) of the three joints in each digit.
Mechanism of injury: three types:
1- Hyperextension: the size of the fragment can range from a small piece of bone up to 30% of the joint surface with minimal communition (usually stable). Treatment: test the stability, apply dorsal blocking splint. Observe the lateral view for any subluxation.
2- Impaction shear: produced by an axial load applied to a slightly extended or flexed PIP joint. The middle phalanx is driven over the head of the proximal phalanx with comminution and impaction of the base of the middle phalanx. Loss of the volar plate tether. Loss of the palmar 50% of the middle phalanx base will make the PIP joint unstable. The extensor tendon and superficialis tendon will aggravate the dorsal subluxation. The splints are inadequate if the injury is not stable. Includes skeletal traction and early range of motion. ORIF if the fragment is large enough. Palmar plate arthroplasty: advance the palmar plate into the defect. Support the palmar plate by filling the defect behind it with fracture chips or bone graft or by superficialis slip. Chronic cases: difficult problem, can do arthrodesis or volar plate arthroplasty.
3- Pylon: a pylon fracture results from axial force that fractures the volar and dorsal articular surfaces with impaction of the central part. A pylon fracture is not a true fracture dislocation will result in a bad outcome. Use dynamic external rotation to help in ligamentotaxis. Allow early range of motion to help remodeling of the joint. Depends on the degree of involvement of the articular surface.
Classification (Hastings): depends on the degree of involvement of the articular surface.
Type I: stable,30%
Type II: tenuous = 30-50%
Type III: unstable less than 50%
Treatment: dorsal extension blocking splint if the PIP can be reduced in less than 30% of flexion, if 40% joint involved and stable. (Type I or Type II- decrease flexion gradually every week). Type III ORIF, volar plate arthroplasty, hemi-hamat great, if 40% joint involved and unstable.
Hemi-hamate graft: the damaged palmar lip of the middle phalanx with a size matched portion of the hamate bone obtained from its distal dorsal articular surface between the 4th and 5th metacarpals. It restores both articular congruity and osseous stability.
Extension block pinning: this technique is described and is probably helpful. Treatment must provide stable reduction allowing early mobilization. Stability of the reduction depends on the size of the avulsed fragment and the amount of the ligament remaining attached to the middle phalanx. If less than 40% of the articular segment is avulsed, some of the collateral ligament will be intact. This will keep the reduction stable. If more than 40% of the articular segment has avulsed, only very little or no ligament will remain attached to the base of the middle phalanx, rendering the reduction unstable.
Recognizing subluxation: AP and lateral x-rays are necessary for diagnosis. An AP view will help to recognize impaction fractures. Subluxation can be missed on x-rays. Look for the characteristic “V” sign of diverging joint surfaces, which indicates injury and subluxation.
Indication for nonoperative treatment: if reduction of the avulsion fracture is achieved with less than a 30-degree bend, nonoperative treatment is a good choice. However, if it takes more than 30 degrees of flexion to reduce the fragment, this may be an indication for surgery.
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Background music provided as a free download from UA-cam Audio Library.
Song Title: Every Step
Supremely helpful! I reviewed this months ago and coming back to it now again, and maybe again...it's that informative. Many many thanks!
On behalf of all ER physicians, thank you
Dear Professor
thank you so much for your educational videos. They always are clear and of high contents.
I was wondering what do you think about the use of sonoelastography in the orthopedic diagnosis and also in the diagnosis and follow up of the reumatic hand.
Thank you very much
thanks for sharing...
Please do base of middle pip joint avulsion fracture, your videos is very helpful.
Thank you for your kindness,
This video is very helpful....
thank you dr.
can you make a video about osgood schlatter disiese?
I have to watch this on a severely cracked screen with a pylon fracture that is 6 months old and bones are doing the nonunion thing. Please say something on how to heal as I cannot see.
I shattered my leg 23 times, and now have 2plates and 28 more screws in my left leg( shattered pelvis and had screws in that and lower lumbar w rod in shattered femur.) Please help
i cut mt flexor tendon little finger fds and fdp,. now 3 weeks in my finger doesnt bend as much as it used to even if i force it passively
its almost as if something is stoping my pip joint to bend more than 90 degree
I got some scar tissue but its soft dont think it can stop my passive motion with my other hand
SO WHATS stopping my finger to bend any further with passive force???
I've recently had a volar plate avulsion fracture, 2nd finger non dominant hand, I estimate around 30-40% of joint compromise, I hope I have a good outcome after surgery, since I want to be a surgeon and am also a musician
How did it go?
@@jz1247 its been 7 months since surgery, functionally it has recovered in 95% I would say, I can do almost everything I did before the accident, I play bass guitar and it starts to ache (Not much) when I play hard for several minutes/hours. I can do the joint flexion almost totally, the extension is limited in its maximum range but it doesnt affect my daily life. Anatomically there are some aesthetic changes in the finger that doesnt affect its function. Overall it's pretty ok.
Can this be straighten if its been years i have this middle knuckle was fractured when i got hit but my mom was really drunk she actually didn't know what i was talking about when i brought it up to her years later .
But yeah i got hit with broom srick my finger 🤞 was more bent than that but my ring finger i was basically throwing up a W and crying. I was young my finger broke without me even knowing at first. Its heald now but slight crooked.
For the age i was its crazy there got to be a God i was real young and i wrapped it and straighten it best i could on my own . Crazy now when i think about it
I just noticed I had this actually all my fingers have this expect 1 pinky
the after injuries , i dont know why my index finger cant be bend
how is it now? did you get surgery?
@@ercushkakulmetov7458 i had filled pain almost 4 month, i just try traditional cure, coz i didt have much money.. And now my pain was gone but my fingger still can't be bend 🤣😊
@@MrKresek same here, i got orif, i can bend, dr said its gonna take 2 months, but now 3 months passed no outcome, u ? whats your condition ?
@@asifbinkabir5138 i wanna know how your.fingers doing right now? mine is 2 weeks old
@@MrKresek is your finger ok now without thr help of surgery?
I’m healing from 1 right now
Sucks
😊