Closed reduction and internal fixation of proximal phalangeal fractures

Belsky, Mark R.; Eaton, Richard G.; Lane, Lewis B.

doi:10.1016/s0363-5023(84)80023-4

Cited by 159 publications

(63 citation statements)

References 6 publications

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“…Incidence of infection, fracture displacement, nonunion, and pain have been cited as reasons to delay motion until the fixators are removed. 9,54 Advances in osteosynthesis materials is believed to provide sufficient stability to permit controlled, protected ROM exercises with this type of fixation in place. 8,32,44,78 Weiss 109 investigated initiation of motion at 1, 2, 3, and 4 weeks for individuals with proximal phalanx (P1) fractures with K-wire fixation.…”

Section: Is Closed or Open Reduction Required?mentioning

confidence: 99%

Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts

Hardy¹

2004

J Orthop Sports Phys Ther

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Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed-and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closedand open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.

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Section: Is Closed or Open Reduction Required?mentioning

confidence: 99%

Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts

Hardy¹

2004

J Orthop Sports Phys Ther

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“…Of the 8 fractures treated, 25% achieved excellent and 62.50% achieved good total active range of motion which is inferior to results observed by Belskey et al and Green and Anderson. Belskey et al in their series of 100 cases of phalangeal fractures, treated by closed reduction and percutaneous Kirschner wire fixation, have reported 60% excellent results [17] . Similarly Green and Anderson treated 26 fractures and reported excellent total active range of motion in 18 of them (68%) [18] .…”

Section: Discussionmentioning

confidence: 99%

A prospective study to analyse various methods of surgical fixation of metacarpal & phalangeal fractures

Gupta¹,

Kumar²,

Rakesh³

2018

Int. J. Orthop. Sci.

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Introduction: Fractures of metacarpals and phalanges are among the most common injuries seen in emergency departments, constituting between 14% to 28% of all visits. Though large number of hand fractures can be treated conservatively, but in some fractures like unstable, intraarticular and malrotated fractures, operative treatment is indicated. The present study was undertaken to evaluate the results of surgical stabilisation of metacarpal and phalange fractures of the hand. Method: A total of 25 patients of metacarpals and phalanges fractures of hand were included in this prospective study during the period April 2010-July 2013. Fractures were fixed with various fixation method as indicated. I.e. ORIF with Plate, ORIF with Screws, CRIF with Kirschner wires or External Fixator. Final evaluation of patients was done at the end of six months, based on criteria for American society for Surgery of Hand. Results: A total of 34 digits were involved in 25 patients. 32.35% of the fractures were spiral/ long oblique followed by 29.41% short oblique followed by comminuted and transverse fractures. Most of the patients were treated by Open reduction and internal fixation with plates and screws (47%) followed by fixation with screws and kirschner wire. A total of 12 minor complications were observed in 10 patients out of a total of 25. Finger stiffness was the most commonly observed complication. Overall end result was graded as acceptable in 97.03% (excellent to good) and non-acceptable in 02.94% (fair) cases. Conclusion:In conclusion, our series suggests that in low-severity fractures treated with miniature plates and screws, very favourable outcomes should be expected. Screw fixation was observed to give excellent results in spiral fractures of metacarpals and phalanges, while fixing fractures with kirschner wires trans fixation of joints should be avoided to get optimum results. Early mobilization is the key to get excellent functional results in all hand fractures.

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“…The natural support provided by the muscles to the shaft of long bones is lacking in the short bones of the hand [10] . The fractured fragments are greatly influenced by the pull of tendons [5] . ligamentotaxis principle is basis of distractor fixators to obtain alignment and length [11] .…”

Section: Discussionmentioning

confidence: 99%

“…This stable bony construct will expedite early mobilization to prevent adhesions and improves functional outcome. There are numbers of external fixators which are versatile in the designs but needs thorough expertise to use [5] . But limitations to use these kind of fixators is high expense and unavailability [6] .…”

Section: Introductionmentioning

confidence: 99%

Simple low cost static external fixators for phalangeal fractures of hand

Tank¹,

Patel²,

Patel³

et al. 2018

Int. J. Orthop. Sci.

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Introduction: Fractures of phalanges are the most common fractures with Incidence of 2.9% every year. They are more common in the young to middle-aged males. The phalangeal fractures are usually considered as simple injuries. Such kind of injuries may results into deformity, if not addressed properly at beginning. Phalangeal fractures with unacceptable angulation and rotations in any plane require operative fixation. There are numbers of external fixators which are versatile in the designs but needs thorough expertise to use. We describe a simple, low cost, 'easy to construct and easy to use' external fixator which can be used for a variety of hand fractures, particularly in an emergency setting as well as definitive fixation. Method: There were 27 patients with different types of fracture of phalanges of hand in our study. Among them 19 male and 8 female patients [mean age -31.85 yrs]. There were 7 open fractures and 20 closed fractures. Out of 27 patients, 15 had fractures of proximal phalanx & 12 patients had fracture of middle phalanx. Our technique is to treat with k wire and plastic cap of spinal needle cap as a static external fixator device. One patient with tendon injury and one with skin loss which was treated by plastic surgical intervention. Result: At the end of 3 months of follow up, range of movements and TAM score out of 27 patients 19 had an excellent result (range 220-260), 5 patients had a good result (range 180-219)and 3 with fair result (range 130-179). Conclusion:This technique is simple, low cost, reproducible, easy applicabilty in the management of fractures involving the small bones of the fingers where complex fixators are not available or costly or needed expertise. Complex Unstable fractures can be converted into stable fractures by this robust and reproducible method. We recommend this simple, low cost, 'easy to construct and easy to use' fixator in the management of fractures involving the small bones of the fingers.

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Closed reduction and internal fixation of proximal phalangeal fractures

Cited by 159 publications

References 6 publications

Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts

Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts

A prospective study to analyse various methods of surgical fixation of metacarpal & phalangeal fractures

Simple low cost static external fixators for phalangeal fractures of hand

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