Résumé
Proximal interphalangeal joint (PIPJ) fractures remain a clinical challenge, with a wide range of patterns and no consensus on surgical management. Historically linked to poor outcomes, recent reviews have shown favorable functional results evaluated using the QuickDASH score. However, the QuickDASH score may not be well suited for assessing these fractures, as it was not originally designed for the fingers. The primary aim of this study was to evaluate the long-term functional outcomes of patients with surgically treated PIPJ fractures. A secondary aim was to assess the prevalence of a ceiling effect in the QuickDASH, and to compare it with patients’ perception of normal hand function as measured by the Normal Hand Score (NHS).
We retrospectively included adult patients with PIPJ fractures treated surgically at our center between 2013 and 2020, with at least five years of follow-up. Patients were evaluated using standardized clinical assessments. QuickDASH and NHS scores were employed to evaluate patients’ perception of their hand normality, ranging from0 (worst) to100 (best).
At a median follow-up of 8.1years (IQR 5.5–10.9), 30patients were evaluated with a mean age of 51years (SD18). Sex ratio (male:female) was7:3. Affected fingers were evenly distributed, with the dominant hand involved in 57% of cases. Pain scores on the Visual Analog Scale (VAS) were 0. The mean arc of motion was 81 (SD22). Median QuickDASH score was 0 (IQR0–4.5), and mean NHS was 78.1 (SD11.7). A ceiling effect in QuickDASH was observed in 19patients out of 30 (63.3%).
In comparison to prior studies, our research offers a comprehensive evaluation of long-term outcomes following PIPJ fracture surgery. Although the QuickDASH score is often underreported in the literature, available studies tend to demonstrate favorable outcomes. Our findings are consistent with these results and may suggest slightly improved functional outcomes. The presence of a ceiling effect, with patients scoring 0 on the QuickDASH despite not perceiving their hand as fully normal in more than 60% of cases, suggests that QuickDASH may lack the sensitivity to detect residual or mild impairments in the fingers in high-functioning individuals.
This suggests that while the QuickDASH effectively detects major functional deficits, it may overlook more subtle or subjective limitations in cases of near-full recovery – highlighting the need for complementary and more specific outcome measures for fingers.