Journal of Musculoskeletal Trauma

Current Concepts in Management of Phalangeal Fractures: Yohan Lee, Sunghun Park, Jun-Ku Lee; J Korean Fract Soc 2022;35(4):169-181. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.169

Abstract PDF: This review focused on the research published to date on the treatment of phalangeal fractures according to the anatomical location of the finger bones, excluding the thumb. In many finger fracture cases, conservative treatment should be prioritized over surgical treatment. The three determinants of surgical treatment are the presence of an intra-articular fracture, the stability of the fracture itself, and the degree of damage to the surrounding soft tissues. Surgical treatment is recommended when bone fragments of 3 mm or more and distal phalanx subluxation are present in the bony mallet finger, and the main surgical treatment is closed reduction and extension block pin fixation. It is essential to pay attention to rotational deformation asf ractures occur proximally. Since intra-articular fractures can cause stiffness and arthritis in the future, a computed tomography scan is recommended to confirm the fracture pattern. These fractures require anatomical reduction of the bone fragments within the joint, and the instability of the joint itself must be corrected. There are no superior surgical treatment methods. It is therefore advantageous for the surgeon to select a surgical method that he is familiar with and confident of performing, considering the fracture itself and various patient-related clinical factors. Nonunion is rare as a complication of a finger fracture, and finger stiffness is the most common complication. Ensuring rapid joint movement as soon as possible can reduce finger stiffness.

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report: Yongun Cho, Jai Hyung Park, Se Jin Park, Ingyu Lee, Eugene Kim; J Korean Fract Soc 2019;32(4):222-226. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.222

Abstract PDF: This paper reports the use of a traction device for the treatment of neglected proximal interphalangeal fracture dislocations. A 44-year-old man with a fracture dislocation of a right ring finger proximal interphalangeal joint was admitted 17 days after the injury. Closed reduction and external fixation were performed using a dynamic traction device and C-arm under a brachial plexus block. Passive range of motion exercise was started after two weeks postoperatively and active range of motion exercise was started after three weeks. The traction device was removed after five weeks. No infection occurred during the traction period. No subluxation or displacement was observed on the X-ray taken two months postoperatively. The active range of motion of the proximal interphalangeal joint was 90Â°. The patient was satisfied with the functional result of the treatment with the traction device. The dynamic traction device is an effective treatment for neglected fracture dislocations of the proximal interphalangeal joint of a finger.

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Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures: Sang Woo Kim, Chae Chil Lee, Sang Hun Ko, Il Yeong Hwang, Min Seok Kim, Woo Young Jin; J Korean Fract Soc 2019;32(1):1-5. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.1

PURPOSE
This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.
MATERIALS AND METHODS
Seven patients, who were diagnosed with comminuted intra-articular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.
RESULTS
The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100Â°), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.
CONCLUSION
DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

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Treatment of Neglected Proximal Interphalangeal Fracture Dislocation Using a Traction Device: A Case Report
Yongun Cho, Jai Hyung Park, Se-Jin Park, Ingyu Lee, Eugene Kim
Journal of the Korean Fracture Society.2019; 32(4): 222. CrossRef

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Irreducible Open Dorsal Dislocation of the Proximal Interphalangeal Joint: A Case Report: Youn Tae Roh, Il Jung Park, Hyoung Min Kim, Jae Young Lee, Sung Lim You, Youn Soo Kim; J Korean Fract Soc 2015;28(1):65-70. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.65

Abstract PDF: Dorsal dislocation of the proximal interphalangeal joint is a common injury in the orthopedic department. In most cases, the joint is reduced simply by closed manipulation. However, in rare cases, the joint is not reducible by closed manipulation, therefore, surgery is required. We report on a case of irreducible open dorsal dislocation of the proximal interphalangeal joint which was surgically treated. Because the flexor tendon interposed between the head of the proximal phalanx and the base of the middle phalanx, we could reduce the joint only after repositioning of the flexor tendon.

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Irreducible Dislocation of the Interphalangeal Joint of the Great Toe with Lateral Collateral Ligament Entrapment: A Case Report: Duke Whan Chung, Bi O Jeong; J Korean Fract Soc 2009;22(2):110-113. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.110

Abstract PDF

Dislocations of the interphalangeal joint of the great toe that are irreducible are very rare. Invagination of the plantar plate or the sesamoid bone into the IP joint, which prevents reduction. To our knowledge, however, dislocations of the IP joint of the great toe that were irreducible because of lateral collateral ligament entrapment, not invagination of the plantar plate or the sesamoid bone, have not been reported by any English literature. We report a 29-year-old ballet dancer who sustained an irreducible dislocation of the interphalangeal joint of the great toe owing to lateral collateral ligament entrapment.

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Open Reduction of a Dislocation of the Interphalangeal Joint of the Great Toe Neglected for 6 Weeks
Jae Kwang Kim, Rag-Gyu Kim
Journal of the Korean Orthopaedic Association.2011; 46(5): 426. CrossRef

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Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report: Yeong Sik Yun, Young Mo Kim, Kyung Cheon Kim, Pil Sung Kim; J Korean Fract Soc 2008;21(4):312-315. Published online October 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.4.312

Abstract PDF

Dislocation of the metatarsophalangeal joint is rare due to the stability of the ligaments and soft tissue surrounding the joint. The authors have experienced lateral dislocation of the first metatarsophalangeal joint, which required surgery, accompanied by complete injuries of medial collateral ligament and capsule, contributing to medial stability, differing from posterior dislocation with intersesamoid complex rupture, with a review of the relevant literature and previous reported cases.

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Dislocation of the first metatarsophalangeal joint concomitant with Lisfranc joint dislocation in a 45-year-old man
Kanoko Mizumoto, Tadashi Kimura, Makoto Kubota, Mitsuru Saito
BMJ Case Reports.2021; 14(6): e243004. CrossRef
Rare Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report and Review of the Literature
Amir Reza Vosoughi, Pascal F. Rippstein
The Journal of Foot and Ankle Surgery.2017; 56(2): 375. CrossRef

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Irreducible Dislocation of the Interphalangeal Joint of the Thumb: A Case Report: Phil Hyun Chung, Suk Kang, Chung Soo Hwang, Jong Pil Kim, Young Sung Kim, Kwang Uk An; J Korean Fract Soc 2008;21(2):165-168. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.165

Abstract PDF: Dislocations of the interphalangeal joint of the thumb are rather uncommon as a result of the inherent stability of the interphalangeal joint. Irreducible dislocations of these joint are rare. The authors report a case of irreducible dislocation of the interphalangeal joint of the thumb with interposed palmar plate, and reduced by open reduction.

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Simultaneous Dorsal Dislocation of Interphalangeal Joints in the Same Finger: Two Case Report: Hyun Seok Song, Suk Ku Han, Sung Jin Park, Won Sik Nam, Hyuk Jae Yang, Nam Yong Choi; J Korean Fract Soc 2006;19(3):388-391. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.388

Abstract

We treated 2 cases of simultaneous dorsal dislocation of interphalangeal joints in the 5th finger. One case was injured by herperextension during basketball, and treated by open reduction and K-wire fixation. Another case was injured by industrial accident, and treated by splint for 1 week.

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Double Dislocation of Interphalangeal Joints in a Single Digit - A Case Report -
Jai Hyung Park, Jeong Hyun Yoo, Joo Hak Kim, In Hyeok Lee
Journal of the Korean Society for Surgery of the Hand.2012; 17(4): 196. CrossRef

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Snapping Metacarpo-Phalangeal Joint after Depressed Fracture of Metacarpal Neck: Case Report: Hyun Seok Song, Nam Yong Choi, Sung Jin Park, Suk Ku Han, Ki Ho Nah, Sang Il Seo, Do Sung Lee; J Korean Fract Soc 2004;17(4):359-361. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.359

Abstract PDF: We report one case of snapping metacarpo-phalangeal joint after depressed fracture of metacarpal neck which could be diagnosed by exploration for the snapping during extension in spite of conservative treatments.

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Treatment of Post-traumatic Dislocation of Metacarpophalangeal Joints of the Hand: Seung Koo Rhee, Seok Whan Song, Joo Yup Lee, Chang Youn Moon, Jae Chan Oh; J Korean Soc Fract 2003;16(2):253-261. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.253

Abstract PDF: PURPOSE
To analyse the obstacles to prevent the reduction for dislocation of the metacarpophalangeal (MP) joints of the hand and evaluate the relationship between the sex and dislocation type in closed reduction case.
MATERIALS AND METHODS
Total 27 cases of MP joint dislocation of the hand (11 cases of thumb, and 14 index and 2 little finger) were reviewed retrospectively. The anatomical structures to prevent the reduction were confirmed at operation and the cases which were reduced immediately were also analysed for their ages and differences of damaged structures, and finally their complications or outcome were reviewed for average 7 months after reduction.
RESULTS
In 11 cases of thumb MP joint dislocations, the complex dorsal dislocations in which the protruded metacarpal neck was caught by buttonhole of torn anterior joint capsule, volar plate and FPB were reduced by open method in 8 cases, and closed reduction was done in 2 cases but one old case required arthrodesis. In other finger MP joint dislocations, the Kaplan's concept to prevent the reduction was confirmed. But reduction of torn volar plate and incision of transverse metacarpal ligament were sufficient to reduce the dislocation with gentle longitudinal traction during the operation. In two cases of little finger MP joint dislocation, the ruptured radial collateral ligaments were noted after open reduction and it must the repaired to prevent the finger instability later. Their overall end results were good without any significant restriction of MP joints motions and finger instabilities.
CONCLUSION
One or two times of closed reduction with proper local anesthesia could be tried, but simple reducible dislocation can be converted to complex irreducible ones by the inappropriate traction method, and so proper reduction technique by closed or even in open way is important with the knowledge of anatomical obstacles to prevent the reduction of the metacarpophalangeal joints.

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Simultaneous Fracture-Dislocation of the Carpometacarpal and Metacarpophalangeal joint of the Thumb: Ho Rim Choi, Sung Jun Han, Sang Seon Lee, Chi won Lee, Byeong Lok Jin; J Korean Soc Fract 1999;12(4):1031-1033. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.1031

Abstract PDF: Simultaneous multiple dislocation of the thumb is a very rare injury. We experienced a case of simultaneous fracture-dislocation of the carponletacarpal and metacarpophalangeal joint of the thumb which was treated by closed reduction and percutaneous K-wire fixation. The clinical retult was satisfactory.

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Operative Treatment of the Malunited Phalangeal Neck Fractures: Ho Jung Kang, Young Gon Koh, Joong Won Ha, Eung Shick Kang; J Korean Soc Fract 1997;10(3):658-664. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.658

Abstract PDF: It is generally accepted that malunited phalangeal neck fracture in hands not only limits range of motion but also accelerates the onset of degenerative changes, with increasing pain and stiffness of the affected joint. When displaced or rotated phalangeal neck fracture presents within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation is excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable. We have followed 9 patients, who had operations for malunited phalangeal neck fractures. The average length of follow up was 27 months. The interval between injury and operation ranged from 4 weeks to 6 years, with a mean of 21 months. Sites of operation include thumbs(3 cases), 2nd fingers(1 case), 3rd fingers(2 cases), 4th fingers(2 cases) and 5th finger(1 case). For those cases with less than 8 weeks elapsed since the injury, osteoclasis of the fracture with fixation using K-wire or pull-out was carried out. For those cases with more than 8 weeks elapsed, realignment osteotomy followed by fixation with K-wire or miniscrew was used. Parameters for the evaluation of result include range of motion to within 10 degree of full range in each joint, deviation of the fingers during active maximum flexion and extension, the minimum distance between the tip of the finger pulp and the palm, full bony union, relief of pain and the subjective cosmetlc result. Excellent and good results were noticed in 7 cases. The best results can be achieved only with near-anatomic restoration of the joint surface and early active motion exercise. In conclusion, with careful patient selection and close attention to operative detail, operative treatment of malunited phalangeal neck fracture can be effective.

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Usefulness of Miniplate Fixation for the Fractures of Metacarpal and Phalangeal Bones of the Hand: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Chul Hong Park; J Korean Soc Fract 1997;10(1):156-163. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.156

Abstract PDF: Before the introduction of internal fixation, the healing of a fracture was an unpredictable event. Internal fixation provides stability, and fractures heal predictably. The miniplate is used for unstable metacarpal and phalangeal fractures of the hand to provide stability and to allow early motion. We analysed 32 patients, 41 cases of metacarpal and phalangeal fractures of the hand which were treated with miniplates from Jan. 1990 to June 1995. The following results were obtained. 1. Mean age was 35 years and the male was predominent(81.3%). The most common fracture site was the metacarpal(51.2%). 2. TAM(total active motion) was 2240 in average and the best result was obtained in the metacarpal fractures(TAM = 239). The roentgenographic union was 16.8 weeks in average. 3. There were 6 complications(complication rate 14.6%) which were 3 cases of joint stiffness, a case of wound infection, a case of loss of reduction, and a case of delayed union. 4. Miniplate fixation is considered to be an useful method to get fracture union and good range of motion with low complication rate in the treatment of metacarpal and phalangeal fractures of the hand.

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Bone Union Rates in Open Phalangeal Fracture of Hand: S W Suh, S H Lee, J G Oh, D Park, K S Kim, C J Kim; J Korean Soc Fract 1996;9(3):782-787. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.782

Abstract PDF: This review was undertaken to analyze the rate of bone union according to accuracy of reduction, methods of fixation, timimg of wound closure and to determine if immediate wound closure increases the infection rate. The materials used in this study included 49 cases of open digital fractures of hand which had been treated at Ansan Hospital, Korea University, College of Medicine from January, 1988 to May, 1995. Of the 38 patients, male were 34(89.5%) and female were 4(10.5%). The average age at operation was 31.9(ranging from 18 to 56 years). On terms of sites of injury within digits, proximal phalanx injured in 18 cases, mid-phalanx16 cases, distal phalanx 20 cases. As a fixatives, K-wire was used in 36 cases(73.5%), mini-plate 8 cases(16.3%), splint immobilization in 5 cases(10.2%). Average time to bone union for K-wire fixation was 12.8 weeks, miniplate was 13.6 weeks, splint immobilization 13.2 weeks. On terms of accuracy of reduction, width of gap between fragments were measured, cases with width of gap less than 2mm were 28 cases(57.6%), cases more than 2mm were 21 cases(42.4%). Bone union periods according to the accuracy of reduction are as follows: cases with width of gap less than 2mm was 11.4 weeks, more than 2mm-15.7 weeks, apposition more than 2/3-12.6 weeks, less than 2/3-16 weeks. Degree of soft tissue injuries was classified based on modified Gustillo-Andersons classification. One case belonged to type I injury, 15 cases to type II and 33 cases to type III. Bone union periods for type I, II was 12.9 weeks in average, and 13.8 weeks for type III.

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Dislocation of First Metatarsophalangeal and farsornetatarsal Joint: Case Report: Chung Soo Hwang, Yong Min Kim, Hyung Ho Oh, Young Un An, Jong Pil Kim; J Korean Soc Fract 1995;8(2):386-390. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.386

Abstract PDF

Dislocation of first metatarsophalangeal joint is a rare condition. Anatomically, the head of first metatarsal is stabilized by various soft tissue structures associated with the sesamoid bones. When the metatarsal head was entrapped underneath the sesamoid complex, it might be impossible to gain reduction via closed method. We experienced a case of dorsal dislocation of first metatarsophalangeal joint and associated dislocation of larsornetatarsal joint in a 32 year old man who was injured by ftll from height. Closed reduction fEiled even under spinal anesthesia. Open reduction via medial approach revealedbuttonholingof the metatarsal head under the sesamoid complex, which had made colsed reduction impossible. Concerning about the rarity and anatomical characteristic of these injuries, we report this case with reviewing of the literatures.

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Lateral Dislocation of the First Metatarsophalangeal Joint: A Case Report
Yeong-Sik Yun, Young-Mo Kim, Kyung-Cheon Kim, Pil-Sung Kim
Journal of the Korean Fracture Society.2008; 21(4): 312. CrossRef

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