Percutaneous Pinning of Fractures in the Proximal Third of the Proximal Phalanx: Complications and Outcomes

Faruqui, Safi R.; Stern, Peter J.; Kiefhaber, Thomas R.

doi:10.1016/j.jhsa.2012.04.019

Cited by 58 publications

(46 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been shown that finger immobilization for longer than 3 weeks can lead to stiffness, so patients with these fractures are usually started on an early therapy program. (8) Despite early motion, many adult patients experience stiffness after surgery and in this previous report, the difficulties in treating the adult with a displaced proximal phalanx fracture are highlighted by the 52% complication rate.…”

Section: Discussionmentioning

confidence: 83%

Pediatric Proximal Phalanx Fractures

Boyer

London

Stepan

et al. 2015

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background The outcomes literature on proximal phalanx fractures in children is sparse. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning. Methods A retrospective chart review identified 105 patients treated with closed reduction and percutaneous pinning of displaced proximal phalanx fractures. Specific complications were recorded for all patients. Thirty-one of these patients returned more than 1 year after surgery for assessment including visual analog scales of pain level, functional ability, and aesthetics. Objective measurements included range of motion, grip and pinch strength, and finger deformity. Radiographs were taken to assess deformity. Results Five of the 105 patients (4.8%) had a complication including infection, pin site complication, or malunion. Thirty- six had stiffness and 31 ultimately underwent hand therapy to regain motion. Subcondylar fractures were associated with a greater likelihood of stiffness. In the 31 patients returning for assessment, the median visual analog scale score was 0 for pain (none), function (full), and aesthetics (perfect). Range of motion, grip, and pinch strength were equivalent to the contralateral side. Seven of the 31 patients (22.6%) had a measureable coronal plane deviation averaging 5° (range 3°-13°) on radiographs. Deviation was associated with subcondylar fractures and a worse aesthetic VAS. Deviation was not associated with worse outcomes overall. Conclusions Pediatric patients with a displaced proximal phalanx fracture treated with closed reduction and percutaneous pinning have an initial notable complication rate related to stiffness; subcondylar proximal phalanx fractures are more commonly affected. At greater than 1 year follow up, patients had full motion, no pain, and were happy with both function and appearance despite minor deformity in some. These complication data may help better inform patients and families prior to surgical intervention.

show abstract

Section: Discussionmentioning

confidence: 83%

Pediatric Proximal Phalanx Fractures

Boyer

London

Stepan

et al. 2015

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…cohort22 (22)P10%N.D.Oblique (64%)Spiral (36%)Mini plate and screwsDorsal approach, longitudinally splitting extensor tendon; splint 2 weeksIVScrews onlyDorsal approach, longitudinally splitting extensor tendon, ≥2 pieces; splint 3 weeksBrei-Thoma [25]Retro. series25 (29)P119%N.D.Basal transverse (50%)Transverse (28%)Oblique (17%)Spiral (6%)Plate and screws, plateDorsal approach/adjusting existing laceration, longitudinally splitting extensor tendon; removable splint 4 weeksIVFaruqui [22]Retro. cohortP10%N.D.TransverseShort obliqueK-wires (transarticular)Antegrade insertion (fixed MCPJ, free PIPJ), 2 pieces; splint 3–7 days, dorsal extension block splint 4 weeks, K-wire removal 3–4 weeksIVK-wires (extra-articular)Cross-pinning from radial and ulnar base, 2 pieces; splint 3–7 days, dorsal extension block splint 4 weeks, K-wire removal 3–4 weeksFranz [17]Pros.…”

Section: Resultsmentioning

confidence: 99%

“…One RCT [19], three cohort studies [20–22] and three case series comprised a total of 186 fractures in 176 patients treated with CRIF. One RCT [19], two cohorts [13, 20] and seven case series [15, 23–28] comprised a total of 198 fractures in 193 patients treated with ORIF.…”

Section: Resultsmentioning

confidence: 99%

“…He reported that industrial workers with extra-articular fractures of the middle phalanx with significant soft tissue crush have a lower active range of motion and take longer to return back to work (Level III). Faruqui [22] did not find a significant difference in active range of motion or complication rate (as defined by authors) between CRIF with transarticular (across the MCP joint) or extra-articular pinning used in closed extra-articular fractures of the proximal phalanx (Level IV). Patients with extra-articular fractures of the proximal phalanx in which initial conservative treatment has failed can be successfully treated with CRIF with transarticular inserted K-wires as is shown by Hornbach [14] (Level IV).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of extra-articular proximal and middle phalangeal fractures of the hand: a systematic review

Verver¹,

Timmermans²,

Klaassen³

et al. 2017

Strategies in Trauma and Limb Reconstruction

View full text Add to dashboard Cite

The aim of the study was to systematically review the patient reported and functional outcomes of treatment for extra-articular proximal or middle phalangeal fractures of the hand in order to determine the best treatment options. The review methodology was registered with PROSPERO. A systematic literature search was conducted in electronic bibliographic databases. Two independent reviewers performed screening and data extraction. The evaluation of quality of the included studies was performed using the Structured Effectiveness Quality Evaluation scale. The initial search yielded 2354 studies. The full text manuscripts of 79 studies were evaluated of which 16 studies met the inclusion criteria. In total, 513 extra-articular proximal and middle phalangeal fractures of the hand were included of which 118 (23%) were treated non-operatively, 188 (37%) were treated by closed reduction internal fixation (CRIF) and 207 (40%) by open reduction internal fixation. It can be recommended that closed displaced extra-articular phalangeal fractures can be treated non-operatively, even fractures with an oblique or complex pattern, provided that closed reduction is possible and maintained. Conservative treatment is preferably performed with a cast/brace allowing free mobilization of the wrist. No definite conclusion could be drawn upon whether closed reduction with extra-articular K-wire pinning or transarticular pinning is superior; however, it might be suggested that extra-articular K-wire pinning is favoured. When open reduction is necessary for oblique or spiral extra-articular fractures, lag screw fixation is preferable to plate and screw fixation. But, similar recovery and functional results are achieved with transversally inserted K-wires compared to lag screw fixation.Type of study/level of evidence: therapeutic III.

show abstract

“…A series of 50 patients with percutaneously pinned proximal phalanx fractures yielded only 1 (2%) superficial pin track infection. 1 Another series of 35 patients with percutaneously pinned proximal phalanx fractures produced 4 (11%) superficial pin track infections. 2 A series of 88 patients with percutaneously pinned distal radius fractures had 14 cases (16%) with pin track infections characterized as ranging from mild to moderate.…”

Section: The Evidencementioning

confidence: 99%

Kirschner Wire Exposure in Hand and Wrist Trauma

Henry

2015

The Journal of Hand Surgery

View full text Add to dashboard Cite

Percutaneous Pinning of Fractures in the Proximal Third of the Proximal Phalanx: Complications and Outcomes

Cited by 58 publications

References 11 publications

Pediatric Proximal Phalanx Fractures

Pediatric Proximal Phalanx Fractures

Treatment of extra-articular proximal and middle phalangeal fractures of the hand: a systematic review

Kirschner Wire Exposure in Hand and Wrist Trauma

Contact Info

Product

Resources

About