Pilon fracture of the proximal phalanx treated with a dorsal approach

A comminuted intra-articular fracture with a central depression of the base of the proximal phalanx is known as a pilon fracture and is relatively rare. Fixation and early motion are needed to prevent pain and stiffness in the metacarpophalangeal (MCP) joint (Dean and Little, 2011). We treated two patients with pilon fractures of the proximal phalanx with screw fixation using a dorsal approach. A 32-year-old man sustained a blow to the MCP joint of the ring finger. Radiography showed a pilon fracture of the proximal phalanx with volar displacement of a fragment. Two days after injury, open reduction and internal fixation were performed through a dorsal longitudinal skin incision, an incision of the radial sagittal band, and after retraction the extensor tendon, we accessed the MCP joint. The dorsal capsule was incised transversely and the radial collateral ligament was partially cut (1/3 of the dorsal width) to expose the articular surface of the proximal phalanx (Figure 1). The fracture was reduced under direct vision and temporarily fixed with 1.0 mm Kirschner wires, which were replaced with three mini-screws (1.5 mm, AO Modular Hand System; Depuy Synthes, West Chester, PA, USA). The joint capsule and collateral ligament were repaired. Radiographic examination revealed that the articular surface of the base of the proximal phalanx was reduced (Figure 2). A bulky hand dressing with a forearm-based dorsal plaster splint was applied in the safe position for the hand and allowing active interphalangeal joint motion exercise for 3 weeks. Then the splint was removed and active MCP joint motion exercises were initiated. Six weeks postoperatively, passive MCP joint motion exercises were initiated. Twelve months after surgery the patient had pain-free, full active and passive range of motion of the ring finger without instability. Radiographic examination showed no osteoarthritis in the MCP joint. He reported a Disability of the Journal of Hand Surgery (European Volume) 2019, Vol. 44(2) 208–218 journals.sagepub.com/home/jhs