The Central Slip Fracture: Results of Operative Treatment of Volar Fracture Subluxations/Dislocations of the Proximal Interphalangeal Joint.

PURPOSE: Fractures of the base of the middle phalanx are particularly challenging. Dorsal fracture-subluxations/dislocations of the proximal interphalangeal (PIP) joint are relatively common, but the volar fracture-subluxation/dislocation, the so-called "central slip fracture," is quite rare. The current study presents our experience with surgically treated patients with central slip fracture subluxation/dislocation with a minimum of 1 year follow-up. We hypothesized that the majority of patients with a central slip fracture-subluxation/dislocation have poor outcomes.

METHODS: Thirteen patients with central slip fracture-subluxations/dislocation were identified from departmental billing records between 2003 and 2013. Nine patients completed the study follow-up examination and 8 were included in the final analysis. Clinical data assessed included age at injury, sex, mechanism of injury, injured digit, type of treatment, additional intervention(s), complications, length of follow-up, and range of motion follow-up. Fluoroscopic images and Quick Disabilities of the Arm, Shoulder, and Hand surveys were obtained at study follow-up.

RESULTS: All patients underwent at least 1 surgery and 7 of 8 underwent open reduction. The average age at the time of injury was 41 years (range, 25-60 years). All injuries were closed. The average follow-up was 43 months (range, 17-67 months). Average passive and active range of motion of the PIP joint at follow-up were 62° and 54°, respectively. Six of 8 patients developed radiographic evidence of arthritic change and 4 experienced an outcome that required additional interventions.

CONCLUSIONS: Patients should be counseled about the outcomes following surgical treatment of this uncommon, difficult injury.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.