gms | German Medical Science

Objectives/Interrogation: The objective of our study was to evaluate the treatment of closed proximal phalangeal fractures with closed reduction and external fixation using a reusable external fixator.

Methods: A retrospective analysis was performed of data collected in a prospective database of all the patients with unstable isolated closed proximal phalangeal fractures of long fingers of the hand treated from 1999 to 2015.

The indication for external fixation was the inability to achieve and maintain a stable reduction with an intra-articular step or gap < 1 mm, an angulation < 10°, a shortening < 2 mm and without any rotational deformity.

Fluoroscopic closed reduction was performed under regional anaesthesia, K-wires were positioned perpendicular to the fracture and connected with a small external fixation system that uses a thicker K-wire as a frame. The K-wires were bended as needed to correct minor malalignment. Immediate postoperative active mobilization was encouraged and continued for 6 weeks. The external fixator was removed after 4 weeks and unrestricted usage of the injured finger was allowed after 8 weeks.

The results were assessed at 4 months and classified as excellent if the total active movement (TAM) was equal to the uninjured contralateral digit and good if the TAM was at least 230° or 85% of the contralateral digit. As poor were classified all the cases with TAM < 230°, an angulation >10°, any rotational misalignment or if any secondary procedure was required to improve the outcome.

Results and Conclusions: 88 patients were treated for closed isolated unstable proximal phalangeal fractures in the long fingers. Nine patients were excluded from the analysis, five due to poor compliance (drug or alcohol abusers or demented) and four due to lack of follow-up. Of the remaining 79 patients, 72 were males and 7 females, with an average age at trauma of 35,8 years. The results were excellent in 25 cases, good in 34 and poor in 20: 74,7% of the patients achieved a good or excellent result (TAM greater than 230°). In patients with poor results there was most frequently an extension deficit of the proximal interphalangeal joint.

The procedure was inexpensive as every set of fixators can be used on average for 20 or more procedures and the only material used were the K-wires.

With external fixation we achieve minimally invasive stabilisation of dislocated and fragmented phalangeal fractures with immediate active mobilization and good functional results while maintaining low running costs.