Traitement des fractures instables de la phalange distale par brochage extra-articulaire de l’IPD : à propos de 12 cas

Unstable distal phalanx fractures are typically treated by pinning of the distal phalanx or the distal interphalangeal joint (DIP). Complications included unstable fixation, K-wire migration, septic arthritis and osteoarthritis. To limit these complications, we wanted to explore the benefits of using locked extra-articular DIP pinning. The cohort consisted of 12 patients (mean age 36.3 years) who had an extra-articular (7 cases) or intra-articular distal phalanx fracture (5 cases). All patients were treated surgically with a construct consisting of two connected K-wires, one was placed inside the medullary canal of the distal phalanx and the other was placed perpendicular to the middle phalanx. The K-wires were removed after 1 month. After an average follow-up of 19.9 weeks, pain was 0.4/10 and the QuickDASH was 7.41/100 on average. The range of motion was, on average, 30.0° less than the contralateral uninjured side for active flexion, 8.8° less for active extension, 32.0° less for passive flexion and 4.1° less for passive extension. The overall hand strength averaged 85.2% of the contralateral side. One secondary displacement occurred but no infection. In all, these findings suggest that locked extra-articular DIP pinning is a simple and reproducible surgical treatment for distal phalanx fractures.