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Minimally-bone-resection Proximal interphalangeal joint (PIPJ) Arthroplasty for Chronic PIPJ Traumatic Arthritis: A Case Report

Proximal interphalangeal joint (PIP) fracture dislocations can result from a hyperextension moment and axial load across the PIP. The injury typically results in a middle phalanx volar base fracture with dorsal joint subluxation. The injury is mainly caused by trauma leading to joint instability and impaired function. Depending on the degree of articular surface involvement and ligament disruption, the injury can display varying degrees of stability. PIPJ osteoarthritis is a common complication which results in pain, stiffness, and loss of function in the affected hand. Treatment of choice for posttraumatic arthritis in PIP joints has remained a controversial subject and a challenge for surgeons. There is a lack of consensus regarding the optimal approach and treatment options for PIP joint arthritis. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. Arthroplasty enables preservation of joint range of motion and improves pain and patient satisfaction; however, there is inadequate evidence to suggest that any implant design or surgical approach is superior to other options.

A 27-year-old male, right-handed, works as a policeman, was referred to the orthopedic department with chief complaint of stiffness on the right middle finger. Six months prior, he had motor vehicle accident which he sustained open dislocation of right middle finger. The patient complained of pain in the middle finger, accompanied by an open wound. After the incident, he underwent operation for wound debridement and K-wire insertion over the right middle finger. After 5 months, the wound on his finger has healed but his right finger could not be straightened. Physical examination revealed a flexion deformity accompanied by limitation on both active and passive flexion-extension range of motion (ROM) of the PIP joint. PIPJ arthroplasty with CapFlex prosthesis was then performed at 6 months post injury.

Postoperative follow-up showed improvement in both active and passive ROM of PIP joint, improvement in joint function, and a good pain relief. Overall, the patient was satisfied with the outcomes of the procedure.

PIP joint arthroplasty is effective in improving pain scores, active ROM, grip/pinch strength and patient-reported outcome measures, particularly in patients with osteoarthritis. In this study, we report a case of PIP joint arthritis treated with arthroplasty. It was able to provide ROM improvement and good functional results.

Proximal interphalangeal joint (PIPJ) Arthroplasty, PIPJ Traumatic Arthritis