Corrective Osteotomy for Post-Traumatic Malunion of the Phalanges in the Hand

Abstract

Rotation, angulation, deviation, shortening or a combination of deformities can occur due to phalangeal malunion and can lead to impairment of hand function. A historical cohort study of 57 patients who had phalangeal corrective osteotomies for posttraumatic malunion between 1978 and 1990 was undertaken. 59 rotational, radial/ulnar deviation, flexion/extension, length adjustment procedures, and combinations thereof were performed, using rigid internal fixation. Concurrent tenocapsulolysis was done in 50% of the cases. Satisfactory correction was obtained in 76% of the patients. Bony union was obtained in all cases. A net gain in active range of motion was achieved in 89% of the patients. Excellent and good results were obtained in 96% of the patients who had corrective osteotomies for malunion involving only the bone and in 64% of the patients who had corrections for malunion with involvement of multiple structures (P < 0.01).

Modified Step-Cut Osteotomy for Metacarpal and Phalangeal Rotational Deformity

“…van der Lei et al 13 contributed data from 9 patients to the literature using osteotomies at the level of deformity using K-wires and AO plates and screws, with a satisfaction rate of 85%. The most recent addition is from Buchler et al, 7 who showed in 7 patients that either phalangeal or metacarpal transverse osteotomies are effective and do not limit postoperative digital range of motion.…”

Extra-Articular Osteotomy for Malunited Unicondylar Fractures of the Proximal Phalanx

“…For these reasons, others have advocated extra-articular osteotomy for malunited fractures in the hand. 8 Light 7 popularized the concept of intra-articular osteotomy for correction of malunions of the hand and wrist in 1987. In his series 6 patients were treated for malunion after an intra-articular condylar fracture of the head of the proximal phalanx.…”

“…They did not address specifically the treatment of intra-articular malunion but did believer that late intra-articular osteotomy as advocated by other investigators 7,9 was not advisable. 8 In 2002 Teoh et al 10 developed an alternative technique for treating intra-articular malunion of the proximal phalanx. In their experience the extra-articular osteotomy provided inadequate correction and intra-articular osteotomy through the fracture site was demanding technically secondary to the small size of the fragment.…”

Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen an der Hand

“…Osteosynthesen im Grundgliedschaftbereich können folgende Fehlschläge aufweisen [18]: Torsionsabweichungen, Achsfehler zur Seite oder in sagittaler Richtung, zu lange Schrauben, die in die Beugesehnen reichen und diese blockieren, Drahtlockerungen, Schraubenausbrüche oder Plattenbrüche mit Pseudarthrosen, vor allem aber die Verklebung der Streckaponeurose mit dem Grundgliedknochen, was zu enormen Bewegungseinschränkungen der Fingergelenke führt [19].…”