Outcomes Following Open Reduction and Internal Fixation in Proximal Phalangeal Fracture with Rotational Malalignment

Abstract

Background: The rotational malalignment in proximal phalanx fracture is unacceptable. Authors attempted to describe clinical and radiographic outcomes as well as complications after open reduction and internal fixation with screw only or plate for phalangeal fractures accompanied by rotational malalignment. Methods: Authors conducted a retrospective review of 46 patients who had been treated between Jan. 2010 and Dec. 2016. The average follow-up period was 16.7 months. A total active motion (TAM), Disability of Arm, Shoulder and Hand score (DASH), and tip pinch power between thumb and fractured finger were measured at the final follow-up. Complications were investigated during the follow up. We assessed the amount of rotation by measuring angle between 3rd ray and fractured finger. The measurement was divided into two groups depending on rotation direction, divergent and convergent direction group. Results: Twenty-eight cases were fixed with mini LCP plate, 12 cases with lag screws, and rest 6 cases with combined. All patients showed solid bony union on radiographs on average follow-up of 68 days (range, 41–157 days). Average TAM of the injured finger was 244 degrees and average DASH score was 4.9 at the last follow-up. Tip pinch power was 3.2 kg, which was not significantly different from that of the contralateral side at 3.4 kg (p = 0.21). The preexisting rotational angle was significantly adjusted (overall, 11.1°). Depending on rotation direction, preoperative 21.7° to postoperative 12.1° in 27 patients of convergent group and preoperative −5.0° to postoperative 8.3° in 19 patients of divergent group were achieved. Conclusions: The rotation from proximal phalanx fractures could be corrected with anatomic reduction by open reduction. Our results showed that open reduction and rigid internal fixation after physical examination for acute proximal phalanx fractures accompanied by rotational malalignment could achieve good clinical results.

Biomechanical performance of a novel light-curable bone fixation technique

“…In a clinical situation with complex fracture morphology, screw placement can be limited, and given the same screw placement, this in situ customizable patch can be widened to increase fracture stability using the same screw placement. Additionally, maintaining rotational alignment in phalanx fractures is an important surgical requirement to ensure functionality and prevent functional impairment 9,25 .…”

Multiple drill hole osteotomy and Herbert screw for correcting a-2 years ring finger phalanx media malunion: A case report

“…The long-term effects of the deformity can upset muscle balance, range from the weakness of pinch and grip, and may cause pain [3] . Furthermore, there was a lack of significant reports on middle phalangeal fracture with rotational deformity, especially in the combination treatment of drill hole osteotomy and headless screw fixation [4] . We present a rotational deformity after distal middle phalanx close fracture after conservative treatment.…”