| Objective:To investigate the clinical outcomes of self-made dynamic traction external fixation combined with limited internal fixation for Pilon fracture of PIP joint.Methods:From October,2016 to December,2017,8 cases of patients with Pilon fracture of PIP joint were admitted to our department,there were 6 males and 2 females.,Aged from 36 to 55 years,averaged 43.5 years.The cause of injury was crush in 6,contusion in 2.The index finger was involved in 3 cases,ring finger was involved in 4cases and little finger in 1 case,they are all closed pilon fractures of PIP joint.clinical performance of PIP joint were swelling,deformity,limited activities because of pain.local tenderness and axial tenderness were obvious.The X-ray showed that the central articular surface was compressed and collapsed,the peripheral articular surface was comminuted and separate.There was no injury of nerve and tendon.the mean time from injury to surgery was 2d,(range,1-5d).8 cases were treated by dynamic external fixator combined with limited internal fixation.Results:After the fracture healed,the external fixator of 7 cases were removed in 4 weeks after operation,and 1 case was removed in 5 weeks.Clinical fracture healing time was 4-6 weeks,average 5 weeks.the needle infection revealed in 1 case in 3 days after operation.We rearranged the traction in 1 case by review of x-ray in 1 week to decrease separation and affect the fracture healing;And 1 cases of articular surface comminuted fracture involving phalangeal shaft restored smooth surface of PIP joint in the first phase,the phalangeal shaft fracture was treated by internal fixation in the second phase and self-made dynamic traction external fixator was an auxiliary treatment method;A recent follow-up outcome measures were as follows,Extension of MP joint was?5°~0°(average,?2°),flexion of MP joint was85 ° ~ 90 °(average,87 °),the mean active range of motion of MP joint was 85 °,Extens ion of PIP joint was?10 ° ~ 0 °,(average,?5 °),Flexion of PIP joint was 80 ° ~ 100 °,(average,92 °);the mean active range of motion of PIP joint was 87°.Extension of DIP joint was-8 ° ~ 0 °,(average,-2 °),flexion of DIP joint was64 ° ~ 80 °,(average,68 °)the mean active range of motion of DIP joint was66 °.The average grip strength is 88% of the unaffected side,and the average pinch strength is 90% of the healthy side.In the last follow-up survey,the patients in this group were measured with two points of static discrimination,all of which were in normal ranges,and did not indicate the performance of nerve injury.According to the VAS score,we divided the pain into level 0-10,as the number increased,the pain gradually rose,3 patients appeared intermittent PIP joint pain after surgery,the vas(visual analog pain score)score was 1 minute,the pain gradually reduced over time.The average Quick DASH score is 4(range 0 ~ 7).X-rays showed that all fracture lines had disappeared and healed well without traumatic arthritis,joint degeneration and semi-dislocation.There were PIP joint space narrowing and fusiform arthrocele(2 cases),joint incongruity(< l mm)(2 cases)but the function had no obvious effect.The patients with better functional recovery generally recovered the function of grasping,kneading and holding,and restored the labor force and returned to work after the injury for 5 months.Subjective satisfaction evaluation was divided into satisfaction,fair and dissatisfaction.Satisfaction(7cases),fair(1 case).One woman thought that external fixator was exposed outside,affected the appearance and felt unaccepted.Conclusions:When properly indicated,using self-made dynamic traction externa l fixator combined with limited internal fixation in the treatment of Pilon fracture is simple ? convenient,fixed and reliable,it can also maintain joint reset,reduce the compression.The advantage of external fixator is helpful in the reduction,earlier rehabilitation,preventing the contracture and adhension of the PIP joint. |
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