Miniplate and Kirschner wire internal fixation for the treatment of typeⅤ flexor digitorum profundus avulsion
Objective To evaluate the clinical efficacy of miniplate and Kirschner wire internal fixation for the treatment of type Ⅴ flexor digitorum profundus(FDP)avulsion which was relatively rare,complex,and difficult to treat.Methods From January 2018 to October 2022,17 patients underwent surgical treatment in our department due to type Ⅴ FDP avulsion injury,including 8 cases of type Ⅴa and 9 cases of type Ⅴb.Treatment was performed using an open reduction miniplate and Kirschner wire internal fixation.During the operation,a palm side Brunner incision was designed centered around the distal interphalangeal joint(DIPJ)to expose the fracture end and reduce it.First,a 1.0 mm diameter Kirschner wire was used to longitudinally fix the distal and proximal fracture blocks,while also fixing the DIPJ.Then,a 1.7 mm 4-hole T-shaped miniplate was used to fix the palmar fracture block and the distal and proximal fracture blocks attached to FDP.Postoperative X-ray examination was performed.After the fracture healed,the Kirschner wire was removed and non weight-bearing functional exercise of the DIPJ began.Results Seventeen patients received surgical treatment on average 6.1 days(2 to 11 days)after the injury time.The average follow-up time after surgery was 23.8 months(13 to 44 months),and the fracture healing time was 6 to 7 weeks,with a healing rate of 100％.At the last follow-up,the VAS for finger pain was 0,and there were no nail deformities or X-ray manifestations of osteoarthritis.The range of motion of the proximal interphalangeal joint(PIPJ)was consistent with that of the healthy side.The average range of motion of type Ⅴa DIPJ decreased by 11.3°(5° to 20°)compared to the healthy side,while the average range of motion of type Ⅴb DIPJ decreased by 10.6 °(0 to 20 °)compared to the healthy side.Conclusion The treatment of type V FDP avulsion injury using open reduction miniplate combined with Kirschner wire fixation is reliable in fracture reduction and fixation strength,and can achieve good fracture healing rate and postoperative joint mobility.
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