Phalangeal Fractures Requiring Vascular Reconstruction: Epidemiology and Factors Predictive of Reoperation

Abstract

Background: Demographic information related to phalangeal fractures that undergo simultaneous vascular repair, as well as their complication and reoperation profiles, remain incompletely understood. This study aimed to examine the patient and fracture characteristics influencing the outcomes after these injuries in a large Unites States adult patient cohort and to identify risk factors associated with unplanned reoperation of these fractures. Methods: A retrospective study was performed, identifying 54 phalangeal fractures in 48 patients; all fractures were also associated with vascular injuries requiring repair. Patients with digital amputations were excluded. A manual chart review was performed to collect epidemiologic, radiographic, and surgical outcome information. Results: The incidence of phalangeal fractures undergoing vascular repair was higher in the non-dominant hand, middle finger, proximal phalanx, and phalangeal shaft. Most (52.9%) fractures were due to occupational injury, with the most common mechanism being sharp injuries. More than half of the fractures had a nerve injury, and 13% required a vein graft for vascular repair. More than half of the fractures required at least one reoperation, most commonly due to “stiffness/tendon adhesion” (50%) and “nonunion or delayed union” (21.4%). In multivariable analysis, thumb (odds ratio [OR]: 35.1, P = .043) and index (OR: 14.0, P = .048) fingers’ fractures were found to be independently associated with unplanned reoperation. Conclusions: Phalangeal fractures requiring vascular repair occurred most often in the occupational setting and more than 50% required at least one unplanned reoperation. Injuries sustained in the thumb and index finger were more likely to undergo unplanned reoperation, which may guide initial treatment decision-making and postoperative follow-up.

Peritendinous adhesion: Therapeutic targets and progress of drug therapy

“…It was reported in the literature that the number of prevalent patients with tendon injury are over 320,000 per year in United States, adhesion formation was encountered following surgery in 30–40% of patients with tendon injury and even resulted in loss of function, which is the culprit behind gigantic socioeconomic burden and impaired quality of life [7] , [8] , [9] . Currently, tenolysis still remains standard clinical treatment of PA to remove adhesion tissue in spite of high rate of recurrence and postoperative complications [10] , [11] , [12] , [13] . More challenging and convoluted to prevent than primary adhesion, recurrent postoperative adhesion was reported to have a higher rate of 80% owing to the vicious circle of adhesiolysis surgery, which indicates an urgent demand for timely non-invasive intervention of PA based on biological and genetic innovation in modulating the healing response [14] , [15] .…”