Purpose
Comminuted intra-articular fractures and fracture dislocations of the metacarpophalangeal
(MCP) and interphalangeal joints are challenging. Dynamic external fixation, permitting
early joint motion while still minimizing forces across the healing joint, can result
in acceptable postoperative active range of motion (AROM). However, some fractures
are not initially stable enough for early dynamic motion; further, many available
dynamic external fixation systems are costly and cumbersome. We reviewed our experience
using an external fixator made from a 1-mL syringe and K-wires and report outcomes
using it as a static fixator, dynamic fixator, or configured as a static fixator and
then converted to a dynamic fixator in the clinic.
Methods
Patients with intra-articular fractures and fracture dislocations of the MCP and proximal
interphalangeal (PIP) joints treated between 2014 and 2020 using syringe external
fixators were retrospectively reviewed. We reviewed demographics, mechanisms, treatment
types and durations, and postoperative AROM, as well as complications including infection,
pin loosening, nonunion, hardware failure, and need for further surgery. Patients
were analyzed by the level of joint injury (MCP versus PIP) and by treatment pattern.
Results
After excluding 23 patients with 25 joint injuries who were lost to follow-up or had
inadequate outcome data, 27 patients with 29 joint injuries were reviewed. The average
follow-up was 171 days after surgery. The postoperative AROM at the MCP level averaged
55° for static fixation and 30° for static-to-dynamic fixation. The postoperative
AROM at the PIP level averaged 64° for static fixation, 66° for static-to-dynamic
fixation, and 80° for dynamic fixation. Three pin site infections and 2 loose pins
were reported.
Conclusions
The syringe external fixator is an inexpensive, effective, and customizable treatment
for intra-articular MCP and interphalangeal fractures and fracture dislocations, and
results in acceptable postoperative AROM outcomes and complication rates.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: October 01, 2021
Accepted:
July 28,
2021
Received:
October 1,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
