case_images: PMC11808197_01
case_images: Preoperative radiograph and CT scan of Patient 1. The radiograph shows a split-depression type fracture (red arrow) with impaction of the radial articular surface in the lateral view of the right ring finger (A). The sagittal view shows an impaction of the volar fragment especially on the radial side (yellow arrow) with dorsal subluxation of the DIP joint (B).. DIP: distal interphalangeal
case_images: cureus-0017-00000077260-i01.jpg
case_images: PMC11808197_01_cureus-0017-00000077260-i01.jpg
case_images: FIG1
case_images: Plain radiographs and CT images showed a split-depression type volar fragment with impaction of the ulnar articular surface (Figure 1A). Articular involvement was 57.1% in the sagittal plane (Figure 1B).
case_images: Intraoperative photograph and postoperative radiographs of Patient 1. A T-plate (red arrows) was applied at the volar surface of the distal phalanx (A). The radiographs, in both AP (B) and lateral (C) views, demonstrate the positioning of the plate and reduction of the dorsal subluxation of the DIP joint. The tip of the screws penetrates the dorsal cortex (yellow arrows), and the plate holds the bone fragment in place.. DIP: distal interphalangeal
case_images: cureus-0017-00000077260-i02.jpg
case_images: PMC11808197_01_cureus-0017-00000077260-i02.jpg
case_images: FIG2
case_images: A four-hole T-plate fixation was performed nine days after injury (Figure 2).
case_images: Postoperative finger motion of Patient 1 at 12 months. Full grip (A) and full extension (B) of the ring finger (red arrows). The %TAM was 97.3% at 12 months postoperatively.. %TAM: percentage of total active motion
case_images: cureus-0017-00000077260-i03.jpg
case_images: PMC11808197_01_cureus-0017-00000077260-i03.jpg
case_images: FIG3
case_images: At 12 months postoperatively, the %TAM was 97.3% (Figure 3).
case_images: PMC11808197_02
case_images: Preoperative radiograph and CT scans of Patient 2. The radiographs showing an impaction-type fracture (red arrow) in the lateral view of the right index finger (A). Sagittal view (B) and coronal view (C) show an impaction of the volar ulnar articular fragment (yellow arrows) and a dorsal subluxation of the DIP joint.. DIP: distal interphalangeal
case_images: cureus-0017-00000077260-i04.jpg
case_images: PMC11808197_02_cureus-0017-00000077260-i04.jpg
case_images: FIG4
case_images: Plain radiographs and CT images showed an impaction-type fracture with severe impaction of the ulnar volar side of the articular surface (Figure 4).
case_images: Intraoperative photograph and postoperative radiographs of Patient 2. A two-hole straight plate (red arrows) was applied at the volar surface of the distal phalanx dividing the flexor insertion (A). The radiographs, in both AP (B) and lateral (C) views, demonstrate the reduction of the dorsal subluxation of the DIP joint. The impacted articular fragment was reduced and supported by a screw (yellow arrow).. DIP: distal interphalangeal
case_images: cureus-0017-00000077260-i05.jpg
case_images: PMC11808197_02_cureus-0017-00000077260-i05.jpg
case_images: FIG5
case_images: The impacted articular surface was elevated from the volar fracture site, the volar fragment was reduced, and a two-hole straight plate fixation was performed (Figure 5).
case_images: Postoperative finger motion of Patient 2 at 12 months. Full grip (A) and full extension (B) of the index finger (red arrows). The %TAM was 100% at 12 months postoperatively.. %TAM: percentage of total active motion
case_images: cureus-0017-00000077260-i06.jpg
case_images: PMC11808197_02_cureus-0017-00000077260-i06.jpg
case_images: FIG6
case_images: The %TAM was 100% at 12 months postoperatively (Figure 6).
case_images: PMC11808197_03
case_images: Preoperative radiograph and CT scan of Patient 3. Radiograph and CT scan showing double dorsal fracture-dislocation of the DIP and PIP joints of the right ring finger. The lateral view of the radiograph (A) and sagittal view of the CT scan (B) show a split-depression type fracture of the distal phalangeal base (red arrows). Dorsal subluxation of the PIP joint with displaced and impacted volar fragment of the middle phalangeal base (yellow arrow) is seen.. DIP: distal interphalangeal; PIP: proximal interphalangeal
case_images: cureus-0017-00000077260-i07.jpg
case_images: PMC11808197_03_cureus-0017-00000077260-i07.jpg
case_images: FIG7
case_images: Patient 3, a 52-year-old male baseball catcher, was hit by a ball and sustained a double fracture-dislocation of the DIP and PIP joints of his right ring finger (Figure 7A). In the sagittal plane, articular involvement was 54.8% at the DIP joint and 57.1% at the PIP joint (Figure 7B).
case_images: Intraoperative photograph and postoperative radiographs of Patient 3. A two-hole plate fixation (black arrows) was performed on both the distal and middle phalanges (A, B). Proximal volar cortexes of the distal and middle phalanges were fixed with plates and screws (red arrows) in buttress fashion, and dorsal subluxations were reduced (C, D).
case_images: cureus-0017-00000077260-i08.jpg
case_images: PMC11808197_03_cureus-0017-00000077260-i08.jpg
case_images: FIG8
case_images: PIP joint. Plate fixations were performed on both the distal and middle phalanges four days after injury (Figure 8).
case_images: Postoperative finger motion of Patient 3 at 32 months. Full grip (A) and full extension (B) of the ring finger (red arrows). The %TAM was 97.6% at 32 months postoperatively.. %TAM: percentage of total active motion
case_images: cureus-0017-00000077260-i09.jpg
case_images: PMC11808197_03_cureus-0017-00000077260-i09.jpg
case_images: FIG9
case_images: At 32 months postoperatively, the %TAM was 97.6% (Figure 9).
case_images: Surgical technique. (A) Dorsal fracture-dislocation of the distal interphalangeal (DIP) joint. (B) Subluxation was reduced with the DIP joint flexed, and a 1.0 mm Kirschner wire (K-wire) ( ) was inserted into the dorsal edge of the middle phalangeal head. (C) The DIP joint was extended, and the volar fragment was reduced and temporarily fixed with a 0.7 mm K-wire ( ). (D) A plate (black arrow) was applied over the fragment passing the wire through the proximal hole. (E) A screw (red arrow) was inserted in the distal hole to exert a buttress effect. (F) Then, the temporarily fixed K-wires were replaced with a screw (red arrow).. Figures were created by Masayoshi Ikeda.
case_images: cureus-0017-00000077260-i10.jpg
case_images: PMC11808197_03_cureus-0017-00000077260-i10.jpg
case_images: FIG10
case_images: First, the DIP joint was flexed to reduce dorsal subluxation, and a 1.0 mm Kirschner wire (K-wire) was percutaneously inserted into the dorsal edge of the middle phalangeal head as an extension block (Figures 10A-10B). Then, the volar fragment was reduced and temporally fixed with 0.7 mm K-wires (Figure 10C). The plate was cut down sufficient to cover both the intact cortex and the fracture fragment, and placed as a buttress, passing the wires through the holes of the plate (Figure 10D). After screwing the distal hole in the plate (Figure 10E), the temporarily fixed K-wires were replaced with a screw (Figure 10F).