gms | German Medical Science

Objectives/Interrogation: Management of proximal phalanx fractures has been a subject of debate for a long time. Conservative methods are popular as they obviate the risk of interference with the delicate soft tissue balance around the bone. However, internal fixation methods can provide skeletal rigidity, thereby allowing immediate mobilisation. Recent systematic reviews published by the European Hand Society (2017) show no clear evidence of the superiority of any one treatment method. However, it has been noted that there is a paucity of published literature on this very commonly treated injury. The purpose of this study was to review the results of open reduction and internal fixation of proximal phalanx fractures at our Unit.

Methods: We reviewed outcomes of patients that underwent internal fixation of proximal phalangeal fractures at our Unit between October 2016 and March 2018. The information was collected retrospectively from case notes. K wire fixation and simple manipulations were excluded for the purpose of this review. Information collected included patient and injury demographics, method of internal fixation, union rates, range of movement, functional recovery, complications and secondary procedures, if any.

Results and Conclusions: We found that 102 patients underwent internal fixation with plates and/or screws. The mean age of patients was 38 years old with a fairly even split between left (52) and right (50) hand injuries. All fractures healed with no incidence of nonunion. One patient, with severe crush injury and composite tissue loss, developed infection that required metalwork removal. One patient required metalwork removal due to breakage of implant. 13 other patients required metalwork removal and tenolysis due to tendon adhesions and stiffness. There was a significantly increased correlation between joint stiffness and severity of injury. The remaining patients had excellent recovery and returned to full functional activity.

We present one of the largest series in the literature regarding outcomes of surgical fixation of proximal phalanx fractures. Unlike previous reports, our experience shows good outcomes with few complications. Internal fixation provides rigid stabilization, thereby improving rehabilitation without cumbersome splintage. Comparison with conservative methods is difficult due to the inherent bias in the severity of injury chosen for this treatment modality. Internal fixation remains the method of choice for severe, comminuted and open injuries of the proximal phalanx of hand.