Management of intra-articular fractures of the proximal interphalangeal joint by internal fixation and bone grafting

Introduction Intra-articular fractures of the proximal interphalangeal joint are usually treated by one of many methods of external fixation, but this does not restore the articular surface. We describe a procedure where bone grafting and internal fixation are used to restore the articular surface. Patients and methods A prospective study was conducted in which three patients underwent surgical treatment for this fracture. We describe a surgical procedure where bone graft harvested from the distal radius is packed through a diaphyseal window to restore the articular surface. This is followed by internal fixation with mini-screws. Results The average follow-up was 61 months. At last follow-up the average arc of movement of the proximal interphalangeal joint was 100 deg and the average Disability of the Arm, Shoulder and Hand ( DASH) Score was 2. Postoperative radiographs showed restoration of the articular contour in all three patients. Conclusion The surgical technique described addresses the issues of restoration of the articular surface and permits early mobilisation. The results for our group are excellent and compare favourably with those achieved using external fixators described in the literature.