Stern 1991 - JHS - Pilon fracture of PIPJ

Summary

Pilon fractures of the proximal interphalangeal (PIP) joint are uncommon intraarticular fractures resulting in comminution and depression of the articular surface.

20 patients were treated with 3 methods: splinting, skeletal traction, and open reduction with Kirschner wires.

Splint immobilization is not recommended as it led to arthritis and stiffness.

Open reduction did not achieve anatomic restoration and had complications like infection.

Skeletal traction through the middle phalanx gave radiographic and clinical results comparable to open reduction.

Regardless of treatment, patients had mild limitation of PIP and distal interphalangeal joint motion. Anatomic restoration was not achieved.

Articular remodeling and resurfacing occurred with both skeletal traction and open reduction.

In summary:

Splint immobilization (n=4) - Degenerative arthritis, stiffness

Skeletal traction (n=7) - Good clinical outcomes, articular remodeling

Open reduction (n=9) - Unable to restore anatomy, complications

The authors conclude that splinting is undesirable, open reduction should be approached cautiously, and skeletal traction is a reasonable alternative giving comparable results to open reduction. Articular remodeling occurred regardless of treatment method.