The Syringe External Fixator: An Inexpensive Static and Dynamic Treatment for Comminuted Intraarticular Phalangeal Fractures
Omer Yousaf, MD1; Imran Yousaf, DO1; Kenneth R Means Jr, MD1; Aviram M Giladi, MD, MS2; Ryan D Katz, MD3
1Medstar Union Memorial Hospital, Baltimore, MD, 2The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, 3Curtis Hand Center, The Curtis National Hand Center, Medstar Union Memorial Hospital, Baltimore, MD
Introduction: Comminuted intraarticular phalanx fractures can result in long-term stiffness and disuse of injured fingers, and often require surgical intervention. External fixation of these injuries is a potentially effective technique; however, most systems are expensive or difficult to apply. The use of dynamic external fixation, when appropriate, facilitates early range-of-motion (ROM) and improved initial outcomes. The ideal external fixation system should be affordable, readily available, and modifiable. We present a series of patients with comminuted intraarticular phalangeal fractures treated with an alternative low-cost external fixator that can be converted from static to dynamic during the post-operative period.
Materials & Methods: Seven patients with comminuted intraarticular phalangeal fractures affecting a single digit underwent external fixation. This was done utilizing a single 1mL plastic syringe and Kirschner pins (Figure 1). The mean follow-up period was four months. All seven patients had the most proximal pin removed within one month of placement to allow ROM in a dynamic external fixation mode. We conducted a retrospective chart review for the final ROM of the proximal interphalangeal (PIP), distal interphalangeal (DIP), metacarpophalangeal (MP), or thumb interphalangeal (IP) joints, as appropriate, as well as incidence of fracture union and complications.
Results: All patients achieved union with congruity of the involved joints. Average ROM arc for the six PIP joints was 70 degrees (range 45-80). Two patients had DIP joint involvement in addition to the PIP joint and had 55- and 35-degree DIP arcs of motion. One patient had a fracture involving the MP and IP joints of the thumb with final ROM of 20 and 40 degrees, respectively. One patient had a fixator pin loosen during the postoperative period. At final follow-up, none of the patients had clinically significant stiffness or malunion that required additional treatment. Results summarized in Table 1.
Conclusion: Syringe external fixation allows for placement of a static fixator that can easily be converted to a dynamic fixator in the post-operative period. Our technique uses items that are inexpensive and readily available. This construct facilitates fracture union, has a low incidence of postoperative complications, and has good ROM outcomes for these challenging injuries.
Figure 1: Placement of syringe external fixator on the small finger
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