Pins and Rubber Band Traction System Combined with Internal Fixation for Intra-articular Fractures of the Proximal Interphalangeal Joints.

Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20-81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°-106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°-90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic).

Effect of dynamic traction technique on postoperative complications, stress response and neurological function recovery in patients with petroclival meningioma undergoing microscopic resection / 中国医师进修杂志

Objective:To investigate the effect of dynamic traction technique on postoperative complications, stress response and neurological function recovery in patients with petroclival meningioma undergoing microscopic resection.Methods:The clinical data of 80 patients with petroclival meningioma in Huanggang Central Hospital of Hubei Province from January 2017 to December 2019 were retrospectively analyzed. Among them, 38 cases were treated with automatic retractor technique (automatic traction group), and 42 cases were treated with dynamic traction technique (dynamic traction group). The operation time, postoperative hospital stay, postoperative complications of brain traction injury and the degree of Simpson tumor resection were compared between 2 groups. The levels of serum stress indexes before and after operation were detected, including C-reactive protein (CRP), interleukin-6 (IL-6) and white blood cell count (WBC). Karnofsky performance status (KPS) score was performed 6 months after operation, and the recovery rate of neurological function (KPS score≥80) and recurrence rate were counted.Results:There were no significant differences in operation time, postoperative hospital stay and the degree of Simpson tumor resection between 2 groups ( P>0.05). The incidence of postoperative complications of brain traction injury in dynamic traction group was significantly lower than that in automatic traction group: 4.76% (2/42) vs. 21.05% (8/38), the recovery rate of neurological function 6 months after operation was significantly higher than that in automatic traction group: 83.33% (35/42) vs. 39.47% (15/38), and there were statistical differences ( P<0.05 or<0.01). The serum CRP, IL-6 and WBC in dynamic traction group were significantly lower than those in automatic traction group: (24.11±5.86) mg/L vs. (28.42±5.94) mg/L, (10.52±2.29) pg/L vs. (12.45±2.46) pg/L and (9.24±2.43) ×10 9/L vs. (10.84±2.38) ×10 9/L, and there were statistical differences ( P<0.01). No recurrence was found in both groups. Conclusions:Dynamic traction technique in microscopic resection of petroclival meningioma can effectively reduce the postoperative complications of brain traction injury, reduce surgical stress, promote the recovery of neurological function, and improve the prognosis of patients.

Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint.

Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes.

Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up.

A fracture of the proximal interphalangeal (PIP) joint at the base of the middle phalanx is rare, but is a challenge to treat. Posttraumatic osteoarthritis is a known complication causing impaired hand function and disability. The aim of the present retrospective study was to evaluate characteristics and outcome of complex PIP joint fractures treated by the pins and rubbers traction system (PRTS). Medical records of 42 patients with fractures treated with a PRTS in 1999-2010 were reviewed, and followed-up by questionnaires (QuickDASH, CISS, self-composed questionnaire). Eighteen of the 42 were clinically examined. The fractures were divided into three types of fractures: volar lip, dorsal lip, and pilon fractures. The volar lip fracture was most frequent (26/42; dorsal lip 3/42; pilon 13/42). Most fractures were sport-related (19/42; 45%) and males predominated (M:F ratio = 1.8). All fractures united. Infection occurred in 17/41 (41%) cases. Radiological signs of posttraumatic osteoarthritis were found in 25/41 (61%) patients. In 18/42 patients, where a clinical evaluation was performed, 66% of contralateral total active range of motion (TAM), 93% grip strength, and 100% pinch strength were achieved. The volar lip fracture had the best outcome according to the self-reported QuickDASH and CISS score and regained 77% of contralateral TAM. Fractures of the PIP joint in the middle phalanx can be treated with the PRTS, but reduced mobility, grip strength, infection, and osteoarthritis are seen. The device is well tolerated by the patients, easy to apply, and with ready accessible materials for the surgeon.

External Dynamic Traction Device for Fracture of the Proximal Interphalangeal Joint of the Finger

PURPOSE: We evaluated the results of treatment for proximal interphalangeal joint fractures using an external dynamic traction device. MATERIALS AND METHODS: This study included nine patients with a proximal interphalangeal joint fracture. All patients were treated using an external dynamic traction device. At the mean follow-up of 10.1 months, the range of motion of the involved interphalangeal joint was measured. The clinical outcome was evaluated using Steel's scoring method. RESULTS: The average range of motion was 95degrees (range: 75degrees-110degrees). According to Steel's scoring method, three cases showed excellent results, two cases showed good results, and four cases showed fair results. CONCLUSION: The external dynamic traction device is useful and effective in treating proximal interphalangeal joint fractures. It enables reduction by ligamentotaxis and active and passive range of motion in the early stages of treatment.

Dynamic traction and fixing apparatus in repair of old rupture of patellar tendon / 中华创伤骨科杂志

Objective To explore an effective method of repairing the old rupture of patellar tendon. Methods We designed a new 井-shaped apparatus for traction and fixing which was to be used, under the dynamic conditions, to reduce the patella, loosen the quadriceps m. of thigh, repair the tendon of knee cap and facilitate postoperative exercises with the fixing apparatus on. Results We used the apparatus to repair the tendon of knee cap in 6 cases. The follow up of 8 to 56 months (averaging 26 months) showed that their functions of the knee joint were all satisfactory. Conclusions The 井-shaped external fixation device can be used under the dynamic conditions to repair the old rupture of patellar tendon with the advantages of little contracture of the knee cap and quadriceps m. of thigh, easy fixation after repair and suture, and early exercise of the knee joint. This novel method is simple and recommendable.