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The Management of Acute Fracture Dislocations of Proximal Interphalangeal Joints: A Systematic Review
Anca Breahna1, Anuj Mishra2, Jill Arrowsmith3, Tommy Lindau3. 1Plastic Surgery, Countess of Chester Hospital, Chester, United Kingdom, 2Plastic Surgery, University Hospitals of South Manchester, Manchester, United Kingdom, 3Hand Surgery, Pulvertaft Hand Centre, Derby, United Kingdom

Purpose of Study
A variety of treatment options are available for the management of PIP joint fracture-dislocations. The aim of this study was to perform a systematic review of the surgical and non-surgical interventions for proximal interphalangeal [PIP] joint fracture-dislocations.
Methods Used
A study protocol was designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement.
Due to limited data in the primary assessment, the hypothesis was tested in a secondary analysis of articles that marginally met the inclusion criteria (i.e. studies that included in their cohort patients under 18 years of age). A tertiary analysis was conducted and studies were divided into: closed reduction techniques, open reduction internal fixation [ORIF] and “other studies”.
Summary of Results
Only the range of motion [ROM] at PIP joint and the complications were consistently reported in all studies. The outcome measures were heterogeneous and a narrative synthesis was carried out. The tertiary analysis identified a higher rate of complications and posttraumatic arthritis in the closed reduction group compared to ORIF, whilst similar ROM was achieved with either technique.
Conclusions
The primary analysis of this systematic review found insufficient evidence to make an evidence-based recommendation for the management of acute PIP joint fracture-dislocations. On further analysis, closed treatment was associated with higher risk of complications and arthritis.



Outcomes of closed reduction and ORIF techniques
Outcome
(number of digits on which data is available)
Closed reduction
(number of digits on which data is available)
ORIF
(number of digits on which data is available)
p value
ROM at PIP joint
(n=165)
83 (8-110)
(n=103)
82(10-115)
(n=62)
N/A
Pain score (VAS)
(n=99)
1.5 (0-8)
(n=76)
9 (0-75)
(n=23)
N/A
Grip strength (% of contralateral hand)
(n=66)
95%
(n=53)
85%
(n=13)
N/A
DASH score
(n=81)
6 (0-29)
(n=57)
4 (0-30)
(n=13)
N/A
Radiographic OA at final review
(n=165)
40%
95% CI (31%-50%)***
(n=103)
7%
95% CI (2%, 16%)
(n=62)
p<0.001
PIP joint incongruency
(n=165)
11%
95% CI (6%, 18%)
(n=103)
31%
95% CI (20%, 43%)
(n=62)
p=0.002
Complications
(n=165)
35%
95% CI (26%, 45%)
(n=103)
18%
95% CI (10%, 29%)
(n=62)
p=0.02
Additional procedures
(n=165)
11%
95% CI (6%, 18%)
(n=103)
18%
95% CI (10%, 29%)
(n=62)
p=0.20


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