Our Summary

This research paper discusses a specific type of finger injury known as volar fracture-dislocations of the proximal interphalangeal joint. This is a rare type of injury where a force is applied to a bent finger, causing a break in the back part of the middle bone of the finger and dislocating the joint. This injury is similar to a more common type of injury, but it’s like a mirrored version happening on the back side of the finger.

The main concern with this type of injury is that it disrupts the systems that allow the finger to extend or straighten. When treating this injury, doctors aim to not only fix the broken and dislocated parts, but also to restore this extension system to prevent a particular type of deformity, known as a boutonnière deformity.

The article provides an overview of the existing literature on this topic and discusses the best approaches for treating this uncommon injury.

FAQs

  1. What is a volar fracture-dislocation of the proximal interphalangeal joint?
  2. What is the main significance of this type of injury?
  3. What are the goals of treatment for a volar fracture-dislocation of the proximal interphalangeal joint?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hand surgery for a volar fracture-dislocation of the proximal interphalangeal joint is to follow the post-operative rehabilitation plan closely to ensure proper healing and prevent complications such as a boutonnière deformity. This may include physical therapy exercises, splinting, and regular follow-up appointments with your healthcare provider. It’s important to communicate any concerns or changes in symptoms to your doctor to ensure the best possible outcome from the surgery.

Suitable For

Patients who are typically recommended for hand surgery for volar fracture-dislocations of the proximal interphalangeal joint include those who have suffered an axial force on a flexed digit resulting in an avulsion fracture of the dorsal lip of the middle phalanx with volar dislocation of the joint. These injuries can lead to disruption of the extensor mechanism at the central slip, and surgical intervention may be necessary to restore a congruent and stable joint and prevent a boutonnière deformity.

Timeline

Before hand surgery:

  • Patient experiences trauma or injury to the hand, such as a volar fracture-dislocation of the proximal interphalangeal joint.
  • Patient may present with pain, swelling, deformity, and limited range of motion in the affected finger.
  • Patient undergoes initial evaluation by a healthcare provider, which may include physical examination, imaging studies, and possibly a referral to a hand surgeon.
  • Treatment options are discussed with the patient, including the goals of surgery to restore joint congruency and stability, and to prevent complications such as a boutonnière deformity.

After hand surgery:

  • Patient undergoes surgical intervention to repair the volar fracture-dislocation, which may involve open reduction and internal fixation of the fracture, repair of the extensor mechanism, and rehabilitation.
  • Patient is monitored closely postoperatively for signs of infection, wound healing, and functional recovery.
  • Patient participates in a rehabilitation program to regain strength, range of motion, and function in the affected finger.
  • Follow-up appointments with the hand surgeon are scheduled to assess progress, address any concerns, and make any necessary adjustments to the treatment plan.

What to Ask Your Doctor

  1. What specific type of hand surgery is recommended for my injury?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time and rehabilitation process after surgery?
  4. Will I need physical therapy after surgery, and if so, for how long?
  5. What are the expected outcomes and long-term prognosis following hand surgery?
  6. How soon after surgery can I expect to regain full use of my hand?
  7. Are there any alternative treatments or non-surgical options for my injury?
  8. Will I need any additional imaging or tests before surgery?
  9. What type of anesthesia will be used during the surgery?
  10. How many surgeries of this type have you performed, and what is your success rate?

Reference

Authors: Choke A, Tan RES, Cheah AE. Journal: J Hand Surg Asian Pac Vol. 2024 Jun;29(3):163-170. doi: 10.1142/S2424835524300020. Epub 2024 May 10. PMID: 38726496