Outcomes of Open Reduction and Internal Fixation for Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint Presenting Late

<b>Background:</b> Patients with dorsal fracture dislocations of the proximal interphalangeal joint (PIPJ) may have significant functional impairment. This study aims to present the outcomes of open reduction and internal fixation (ORIF) in patients who presented late with dorsal fracture dislocations of the PIPJ and to evaluate factors affecting the outcomes. <b>Methods:</b> This retrospective study included patients who presented late with a dorsal PIPJ fracture dislocation and underwent ORIF. The outcome measures included active arc of motion (AAOM) of the PIPJ and distal interphalangeal joint (DIPJ), grip strength, Quick disabilities of the arm, shoulder and hand (Q-DASH), Ishida and Ikuta scores. The outcomes data was statistically analysed to determine association of outcomes with the finger involved, mechanism of injury, presence of concomitant injury, delay between injury and surgery, percentage of the articular surface involved, presence of comminution of the volar lip and involvement of proximal phalanx head. <b>Results:</b> The mean surgical delay was 58 days. The average articular surface involvement was 58%. The PIPJ AAOM improved by 72°, with a 10° mean flexion deformity, an average Q-DASH score of 4.8 and grip strength at 84% of the non-operated hand. Eleven patients achieved excellent Ishida and Ikuta scores, two good and four fair-to-poor. Surgical delay had no significant impact (<i>p</i> > 0.05), but less-comminuted fractures and non-cricket injuries showed better recovery (<i>p</i> < 0.05). Concomitant injuries and proximal phalanx head involvement correlated with higher disability scores, lower grip strength and poorer functional outcomes (<i>p</i> < 0.05). <b>Conclusions:</b> ORIF is a viable, joint-preserving surgical option that can be considered in delayed cases up to 2 months. This technique retains the native osteochondral fragments. The surgical approach allows one to convert to hemi-hamate arthroplasty (HHA) as an alternative procedure in the same setting when fracture is not amenable for reconstruction. <b>Level of Evidence:</b> Level IV (Therapeutic).