Intra-articular Osteotomy for Malunited Proximal Interphalangeal Joint Fracture

Intra-articular malunion of the proximal interphalangeal joint is challenging. Multiple treatment options vary from arthrodesis to different types of osteotomy procedures. The aim of this study was to evaluate the effectiveness of intra-articular osteotomy in treating malunited proximal interphalangeal (PIP) joint fractures.

Fifty-nine consecutive patients with chronic PIP joint fractures were presented to us from May 2007 to December 2017. Sixteen joints of 15 patients were malunited PIP fracture without severe cartilage damage and underwent intra-articular osteotomy. The average interval from injury to operation was 4 (1-48) months. The mean duration of follow-up was 9 (2-43) months. Radiographic evidence of bone healing, joint alignment, range of motion of PIP, and distal interphalangeal joints were documented and assessed.

Fifteen patients underwent intra-articular osteotomy. The average age was 32 (15-54) years. Fourteen of them were males. Fractures affect 9 middle phalangeal bases and 7 proximal phalangeal heads. Bony union was obtained in all patients by 6 to 10 weeks after surgery. Pain was relieved in 14 patients and the deformity was corrected in 12 joints of 11 patients. The average arc of motion for involved PIP joints was improved from 30.3 (10.0-39.1) degrees to 68.4 (7.2-75.6) degrees. One patient arose painful degenerative arthritis after surgery. Ten patients were satisfied or very satisfied.

For malunited PIP joint fracture without severe cartilage damage, intra-articular osteotomy provides predictable functional recovery and minimal donor site sacrifice.