gms | German Medical Science

Objectives/Interrogation: The purpose of the study was to assess the adaptation and limitation of the conservative treatment with dorsal block functional cast or surgery for proximal phalangeal shaft and base fractures.

Methods: We retrospectively reviewed the medical records and radiographs of patients from January 2015 to January 2017 with a diagnosis of proximal phalangeal fractures. Outcome was analysed in terms of the alignment of the proximal phalangeal bones and %total active motion(%TAM) at the time of injury and 4 months later after treatment.

Results and Conclusions: Ultimately, 46 fractures in 44 patients (mean age 35.8 years (range=7-76 years), female/male 9/35) were enrolled. Fractures affected index finger (n=7), middle finger (n=1), ring finer (n=7) and little finger (n=31). The type of fractures were condylar fractures (n=16), shaft fractures (n=7) and base fractures (n=23). Surgical treatment was performed for 20 fractures of the condylar fractures, the long oblique fractures with gap and the base fractures with intra-articular fracture. 26 fractures with the conservative treatment were retained good alignment. The alignment at the time of injury and the 4 month later after treatment were volar-dorsal angulation: 21.0, 2.5°, lateral angulation: 11.6, 1.8°, lateral dislocation: 0.9, 0.2mm and shortening: 0.5, 0.4mm. The mean %TAM after the conservative treatment was 92.1%.

All fractures were bone union without overlapping. The proximal phalangeal fractures could be treated conservatively were good outcomes.

However, surgical treatment were needed for the condylar and intra-articular fractures needing anatomical reduction or the long unstable oblique fractures.