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

Abstract

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.

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

“…Phalangeal fractures are the second most common fractures of the upper extremity after fractures of the radius and ulna 1–3 and account for approximately 59% of all hand fractures. 1,2,4,5 Anakwe et al (2011) reported an annual incidence of 1.07 phalangeal fractures per 1000 persons in a single trauma unit in Scotland and similar incidence rates are reported in North America with 12.5 phalangeal fractures per 10,000 persons in the US, 2 and 1.81 per 1000 (95% CI: 1.31–1.73) in British Columbia. 6 About 9.1–22.5% of hand fractures are proximal phalangeal fractures 5,7,8 of which the vast majority, approximately 75–85%, are extra-articular fractures.…”

“…13,14 In the case of an unstable fracture, considerable malalignment and/or involvement of the joint surface, surgery is often indicated. 4,15 However, there are currently insufficient randomised controlled trials (RCTs), systematic reviews and meta-analyses comparing the different surgical treatment options to draw definite conclusions on the superiority of one technique over the other. 4,16–19…”

“…4,15 However, there are currently insufficient randomised controlled trials (RCTs), systematic reviews and meta-analyses comparing the different surgical treatment options to draw definite conclusions on the superiority of one technique over the other. 4,16–19…”

“…9,10 In general, uncomplicated, stable extra-articular fractures without malalignment can be treated conservatively. 4,11,12 Most authors suggest placing the hand in MCP flexion and IP extension as this intrinsic plus position reduces the displacing force of the 1 The University of Derby, UK 2 interosseus muscles that contributes to the apex volar angulation often seen in proximal phalangeal fractures. 13,14 In the case of an unstable fracture, considerable malalignment and/or involvement of the joint surface, surgery is often indicated.…”

Comparison of Miniplate and K-wire in the Treatment of Metacarpal and Phalangeal Fractures

“…Displacement and any neurological and vascular injuries must be treated with early mobilization through open reduction and internal fixation to achieve maximum normal function and anatomy [4]. Early mobilization reduces joint stiffness, edema, and adherence to free normal gliding structures [5].…”