الفهرس 
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Abstract
The proximal interphalangeal (PIPJ) joint injuries are one of the most common injuries of the hand due to its rigid nature. The severity of injury can vary from a minor sprain to a complex intra-articular fracture.
The injury of this highly valuable joint presents a significant surgical challenge. There is a relative difficulty in achieving both anatomical reduction and stable fixation enough to restore its function and facilitate early mobilization. Thus, the main goals of any treatment plan for fracture-dislocation injuries of PIP should focus on maintaining concentric reduction of the subluxated or dislocated joint, restoring stability, facilitating early range of motion (ROM) exercises. In addition, anatomic reduction of the articular surface should be performed if feasible. However, good surgical outcomes could be achieved with good alignment and concentric reduction, even with imperfections of the articular surface. Postoperative complications such as joint stiffness and flexion contracture may occur due to the complex joint anatomy, even after an appropriate treatment.
There is no consensus about the best treatment modality for PIP joint injuries. This study systematically reviewed and compared between different modalities of repair of intra-articular fractures of PIP joint including the dynamic distraction external fixator, extension block pinning, closed reduction and percutaneous K-wire fixation, open reduction and internal fixation and hemi-hamate arthroplasty.
Statistical analysis revealed that ROM following EBP was 83.4 (95% CI 79.5 – 87.2), which indicates lower level of range of motion after surgery than the flexion range from normal PIPJ (>90 degree). ROM following Hemihamate arthroplasty was 78.4 (95% CI 65.6 – 91.1). ROM following ORIF was 77.6 (95% CI 69.2 – 86.1).
The study results also revealed that the grip strength following EBP was 81.4% (95% CI 75.7 – 87.2%), and the grip strength following Hemihamate arthroplasty was 78.3%, and the grip strength following ORIF with mini-screw was 73.4% (95% CI 64.8 – 81.9%).
The study results also revealed that Quick DASH following EBP was 5.3 (95% CI 4.6 – 5.9), suggesting minimal functional impairment, following Hemihamate arthroplasty was 11.9 (95% CI 0 – 25.1), suggesting moderate degree functional impairment. Also following DDEF was 11(95% CI 1.2 – 20.4), suggesting moderate degree functional impairment. As regard ORIF one study assessed Quick DASH score, that was 4. While following CRPP, the score was 8.
The study results also revealed that the most common complications following EBP were degenerative changes, followed by redislocation or subluxation. Only few cases had malunion. The only complications following Hemihamate arthroplasty were arthritis and graft loss. The only complications following ORIF were arthritis and stiffness. The complications following DDEF included loose pins, hyper-granulation at pin sites, extensor lag and adhesion, and cold intolerance.
So, The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of joint damage when used to treat unstable dorsal fracture-dislocations of the PIP joint, although complications could happen.