A Comparative Assessment of Functional Outcomes of Conservative Treatment versus Dynamic External Fixator for Proximal Interphalangeal Joint Fracture-dislocation: Cross-sectional Study

Introduction: Finger joint dislocations, particularly involving the Proximal Interphalangeal (PIP) joint, pose common challenges in hand injuries. Despite various treatment modalities available including extension block splinting, extension block pinning, Open Reduction and Internal Fixation (ORIF), hemi-hamate arthroplasty, volar plate arthroplasty, and Dynamic External Fixator (DFS), comparative studies assessing functional outcomes are scarce. Definitive treatments for a particular type of PIP fracture-dislocation are not defined. Dynamic external fixation is a minimally invasive and cost-effective surgical treatment that allows early joint mobilisation with soft-tissue preservation. Aim: To compare the functional outcomes of conservative treatment versus DFS for PIP joint fracture-dislocation. Materials and Methods: A comparative prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from August 2022 to August 2024. Patients aged 18-50 years with PIP fracture-dislocations less than three-week-old were included. Patients were randomised to receive conservative management using buddy strapping (Group A) or DFS (Group B). Functional assessments, radiographic monitoring, and pain evaluations were conducted preoperatively and at follow-up appointments for a duration of three months. The association between categorical variables was examined using Chi-square tests, with a p-value <0.05 indicating statistical significance. Results: Group B exhibited significant improvements in Range Of Motion (ROM) (88.3±7.7) (p-value=0.001), extensor lag (1.9±1.7°) (p-value=0.013), intra-articular step-off (1.1±1.1) (p-value=0.002), grip strength (81.4±5.9) (p-value=0.001), and pain scores (0.5±0.7) (p-value=0.001) compared to Group A’s ROM (76.3±7.4), extensor lag (3±2°), intra-articular step-off (2±1.3), grip strength (70±6.2), and pain scores (2.2±1.1) at three months follow-up. Disability scores (Quick Dash) were also significantly lower in Group B (10.9±4.4) (p-value <0.001) compared to Group A (31.6±13.5) at three months. Conclusion: DFS-Suzuki frame treatment showed superior outcomes compared to conservative treatment for PIP fracturedislocations. It resulted in improved motion, strength, and pain scores, along with reduced disability