Unstable dorsal proximal interphalangeal joint fracture-dislocations treated with extension-block pinning

Unstable proximal interphalangeal (PIP) joint fracture-dislocations, which can cause significant disability, can be treated with multiple techniques. Extension-block pinning (EBP) allows for early motion and is less technically demanding than alternative surgical treatments. In the study reported here, 12 patients with unstable dorsal PIP fracture-dislocations were treated with closed reduction of the PIP joint followed by percutaneous insertion of a Kirschner wire (K-wire) into the distal aspect of the proximal phalanx. For these patients, extent of articular surface involvement averaged 43% (range, 25%-75%). Active motion was initiated early after surgery, and the K-wire was removed a mean of 25 days after pinning. Radiographic reduction of joint dislocation was achieved and maintained for 11 of the 12 patients at a mean follow-up of 35.5 months. At follow-up, mean visual analog scale (VAS) score was 0.64 (scale, 0-10). Mean score on the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was 5.7, suggesting minimal functional impairment. Mean PIP active motion was 84° (range, 50°-110°). Grip strength was equal between operative and contralateral hands. Patient satisfaction most closely correlated with low VAS and QuickDASH scores. One patient developed a malunion, which was treated with corrective osteotomy. EBP is a simple, safe, and reproducible technique for unstable PIP fracture-dislocations. This technique yields outcomes similar to those reported for more complex surgical procedures.