Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study

Sadek, Ahmed Fathy

doi:10.1177/1753193419894143

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…Multiple authors showed a significantly excellent and good outcome in operation group than in conservation group [ 1 , 5 , 17 , 18 ]. While the outcomes were no significant differences between conservation group and operation group among excellent, good, and fair in our study.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Wang

Huang

et al. 2023

Journal of Pediatric Orthopaedics B

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To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children’s Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman’s rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.

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Section: Discussionmentioning

confidence: 99%

“…Goodell, Bauer and Sadek determined that closed reduction without pinning is associated with nonunion and its insufficient in maintaining the reduction in type II phalangeal neck fractures [ 17 , 18 ]. Among our 40 patients, there was no case of fracture nonunion or phalanx avascular necrosis at the last follow-up.…”

Section: Discussionmentioning

confidence: 99%

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Wang

Huang

et al. 2023

Journal of Pediatric Orthopaedics B

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“…A minimum of two wires should be placed whenever possible to confer stability. Dual wires placed in a parallel or crossing fashion have demonstrated satisfactory outcomes with few complications (Sadek, 2020). Oblique condylar splits with proximal propagation are amenable to fixation with multiple wires placed slightly divergent to each other.…”

Section: Proximal Phalangeal Fracturesmentioning

confidence: 99%

Fractures of the phalanges

Heifner,

Rubio

2023

J Hand Surg Eur Vol

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Fractures of the phalanges encompass a wide range of injury patterns with variable articular and soft tissue involvement. The goals of treatment whether conservative or surgical are the restoration of function while limiting the risk of complications. An armamentarium of fixation options allows the surgeon to appropriately treat these fractures with the intention of initiating early postoperative mobilization. Previous publications report variable rates of complications following internal fixation of phalangeal fractures which represents an unsolved problem. It is incumbent on the surgeon to utilize meticulous surgical technique, achieve anatomic reduction with stable fixation and initiate early postoperative mobilization where indicated. In the following text, we review the management of most types of phalangeal fractures, except fracture-dislocations of the proximal interphalangeal joint. These injuries comprise a wide spectrum of presentation; thus, an understanding of anatomical and mechanical principles is integral to achieving a successful outcome.

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“…13,[21][22][23] It is suggested in the literature to start mobilization exercises as soon as fracture stability can be assured to prevent scarring, adhesion formation, and joint stiffness. [23][24][25][26] The systematic review of Feehan and Bassett 27 (2004) concluded that early motion facilitated a faster recovery of metacarpal fractures, which can lead to a quicker resumption of activities of daily living and an earlier return to work. However, no articles on proximal phalangeal fracture management met the eligibility criteria and due to this, the benefit of early motion in this patient population could not be demonstrated at that time.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation following extra-articular proximal phalangeal fractures of the fingers in adults: a scoping review

2023

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Introduction Proximal phalangeal fractures are common and can have a significant impact on hand function. Therefore, it is important to optimise post-operative rehabilitation. A scoping review was undertaken to map the existing evidence on rehabilitation of proximal phalangeal fractures of the fingers in adults. Methods A comprehensive search was conducted which included database searching, reference searching, hand searching of journals, and searching for grey literature. Eight articles were included after screening for eligibility. Results Three studies researched surgical interventions and five studies conservative management. The immobilisation period varied between 5 days to 3 weeks in the surgical studies, and between 3 to 7 weeks in the conservative studies. Active exercise therapy was started immediately with conservative management, while in the surgical studies time to commence exercises varied between 5 days and 3 weeks. All studies reported good results in mobility with a mean total active motion ranging from 240° to 258.9°. Patients reported little pain at final follow-up and grip strength recovered to 96% compared to the unaffected side. Studies reporting on function and patient satisfaction lacked transparency. Conclusions All studies had a moderate to high risk of bias and the results of the included studies should therefore be interpreted with caution. More high-quality randomised controlled studies with an a priori research protocol and a standard set of outcome measures are necessary to research whether early motion, an intrinsic plus splint leaving the wrist free, and the inclusion of additional treatment modalities can result in a better and/or faster recovery.

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Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study

Cited by 8 publications

References 25 publications

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture

Fractures of the phalanges

Rehabilitation following extra-articular proximal phalangeal fractures of the fingers in adults: a scoping review

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