Indicated for dorsal fracture dislocations of the PIP.
Indicated for the treatment of unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint of the fingers in which external fixation as provided by the PIP Fix alone is sufficient to obtain and maintain concentric reduction of the fracture dislocation during bone and soft tissue healing
Capable of exerting both palmar translating forces to the middle phalanx and length restoration forces to the PIP joint
Palmar translation and length restoration forces are easily adjusted
Pin Placement Guide that holds the fracture reduced during bone pin installation and facilitates precise pin insertion
Obtains and maintains joint alignment by a method that permits active ROM exercises
Minimally invasive procedure that requires the percutaneous insertion of only two bone pins
Radiolucent device and pin placement guide that optimizes fracture visualization
Sold in a complete sterile kit
For the PIP Fix to obtain and maintain joint realignment, 50% or more of the dorsal base of the middle phalanx, from the radial to ulnar sides, must be intact.
AP, lateral and both oblique x-rays are necessary pre-op, and during PIP Fix installation and adjustment, to confirm an adequate portion of the intact dorsal base of the middle phalanx can be concentrically realigned with the condyles of the head of the proximal phalanx.
The Pin Placement Guide holds the middle phalanx reduced while the pins are inserted. If manual reduction of the joint is not possible, the surgeon must use best judgement to determine the optimal Transverse Pin location based on the relevant alignment of the soft tissues with the skeletal bones.
X-ray translucence of the guide makes it easy to see where the bone pins are being placed. Adjustment knobs for both pins make precise placement easier. In addition, it ensures that the bone pins are inserted perpendicular to each other.
Once the PIP Fix is installed, use lateral x-rays to confirm that realignment of the dorsal base of the middle phalanx is maintained during active or passive joint motion. If, during active or passive motion, gliding motion arrests and the dorsal side of the joint “opens like a book”, the sharp palmar edge of the intact dorsal base is digging into and abrading the hyaline cartilage of the head of the proximal phalanx. If this “rocking” motion persists, the potential for gliding motion is lost and this abnormal motion will evolve into traumatic arthritis.
The device’s reduction force should create normal alignment of the intact dorsal base of the middle phalanx on the head of the proximal phalanx. Maintenance of this alignment requires capsular ligaments that are competent to assure joint alignment and prevent palmar subluxation of the middle phalanx on the head of the proximal phalanx.
If length restoration is needed, the Angle Lock Screw may be loosened and the device rotated to provide a variable and customizable ratio of palmar translation to length restoration forces.
The minimally invasive procedure and the ability to perform ROM exercises during fracture healing helps prevent finger stiffness.
NOTE: The definition of an optimal result depends on the geometry of both the bone and soft tissue injury that accompanies each of these difficult fractures. Please study the anatomic and technical issues carefully before deciding to use the PIP Fix.