Modern aspects in the treatment of intra-articular fractures and fractures of the proximal interphalangeal joints of the three-phalangeal fingers of the hand, as well as their consequences

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the finger’s function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both “acute” and long-standing injuries, each with advantages and disadvantages.

OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).

MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.

RESULTS: The patient estimated the VAS pain syndrome at 4–6 points on the scale; however, after 6–8 weeks, this indicator was 0–1 points. After 6–8 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 30–50° after 6–8 weeks, was reached the average of 15–95°. There was a 15–20° extensor contracture in two patients.

CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.