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

Abstract

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.

A Systematic Review of Conservatively Managed Isolated Extra-Articular Proximal Phalanx Finger Fractures in Adults

“…This is the first systematic review to the authors’ knowledge which provides a focused overview of conservatively managed extra-articular P1 fractures in adults, and supports previous studies in this domain. A recent scoping review by Vervloesem et al 22 in 2023 identified current methods of rehabilitation following conservative and surgical methods of management for extra-articular P1 fractures. It included 267 fractures from eight articles, five of which examined conservative interventions.…”

“…Limitations of this study are similar to those identified in two previously published reviews. 21 , 22 The included articles had significant variability in study design and poor reporting quality. The orthotic design and duration of wear differed greatly between studies, often with little justification.…”