Post-Traumatic Malunion of the Proximal Phalanx of the Finger. Medium-Term Results in 24 Cases Treated by “In Situ” Osteotomy

Abstract

We report the clinical and radiographic medium-term results obtained for 20 patients (24 fingers) treated surgically for post-traumatic malunion of the proximal phalanx of the finger. In all cases we performed a corrective osteoclasia or osteotomy at the site of malunion, followed by miniplate and screw fixation or by screw fixation only. The corrective osteoclasia was performed when malalignment was addressed within six weeks after injury. Two patients who had two fractures underwent additional surgery (tenolysis and/or capsulolysis) to improve function and ROM. At the final follow-up, at a mean of 24 months after corrective surgery, good or excellent clinical and radiographic results were obtained in all the patients. The pseudoclaw deformity disappeared in all cases in which a volar angulation deformity was present. An average improvement of about 30% in the range of motion of the MP and PIP joints was observed; only 4 patients complained of mild pain at the maximum degrees of articular excursion of the MP and PIP joints. All the patients presented an improvement in grip strength. The mean DASH score in our series was 5 points. In two of the four cases treated by an intra-articular corrective osteotomy, mild radiographic signs of osteoarthritis at the MP joint were present. The data for this study confirm that “in situ” osteotomy stabilized by miniplates and/or screws is an effective procedure to correct post-traumatic malunions of the proximal phalanges of the fingers.

A Simple, Easy, and Reliable Technique of Phalangeal Corrective Osteotomy for Overlapping Fingers

“…Potenza et al 2 reviewed the results of 24 phalangeal in situ osteotomies, and 2 of the 24 (8%) patients had a secondary tenocapsulolysis. Büchler et al 6 recorded secondary tenocapsulolysis in 5 of 25 (20%) patients who underwent proximal phalangeal osteotomies.…”

“…Corrective osteotomies with either lag screws, interosseous wires, K-wire fixation, or plate and screw fixation have been previously described. 2 , 4 , 6 , 9 , 12 A rigid osteosynthesis better tolerates the strain of aggressive postoperative therapy, particularly when tenocapsulolysis is performed. The plate and screw construct can provide the greatest stability among the above-mentioned techniques, which allows exercise of the hand to begin immediately so as to limit stiffness.…”

“…It is a relatively long time compared with published phalangeal osteotomy series that have healed within 7–8 weeks. 2 , 4 , 9 This may in part be attributable to the osteotomy being performed at the mid-portion of the phalanx, where there is less total surface area for union. However, bone union was accomplished in all cases, and the final results were excellent or good.…”

“…A consensus has yet to be reached on whether it is better to correct an angular deformity by an open wedge 6 or by a closed wedge method. 2 , 4 , 8 A closed wedge osteotomy is considered easier to perform and avoids the need for bone grafting, but it shortens the phalanx. A cadaver study 18 revealed that shortening of the phalanx causes a relative extensor tendon lengthening and a subsequent extensor lag, which can develop into a pseudoclaw deformity of the finger.…”

“…Malunion of the phalangeal bone may cause cosmetic deformities and functional deficits that include scissoring or overlapping of the fingers, a disturbance in tendon balance, and a reduction of grip strength. 2 Thus, surgical intervention is necessary for this condition. However, previously described techniques require precise geometric assessment of the deformity and complicated preoperative plotting.…”