Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures

Köse, Ahmet; Topal, Murat; Engin, Muhammed Çağatay; Şencan, Ayşe; Dinçer, Recep; Baran, Tuncay

doi:10.1007/s00590-018-2342-4

Cited by 19 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Various closed and open surgical techniques have been proposed for the treatment of phalangeal fractures and metacarpal fractures, including closed reduction and percutaneous pinning, intramedullary nailing, open reduction and screw fixation, and plate fixation [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Controlled active exercise after open reduction and internal fixation of hand fractures

et al. 2021

View full text Add to dashboard Cite

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes.Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed.Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up.Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

show abstract

Section: Introductionmentioning

confidence: 99%

Controlled active exercise after open reduction and internal fixation of hand fractures

et al. 2021

View full text Add to dashboard Cite

show abstract

“…An important finding was that open reduction seemed to have lead to a worse clinical outcome regarding the functional scores than a closed reduction technique, despite a similar range of motion, strength and pain level. Other studies showed a similar clinical outcome between an open reduction using a screw or plate fixation and a closed reduction using a K-wire fixation in proximal phalanx fractures, while others found a worse range of motion and grip strength in the closed reduction group [11,19]. Because the functional scores were worse in the open approach group in our study, it seems advisable that the surgeon should try to perform a closed reduction whenever possible and feasible to achieve the best clinical outcome with regard to the patient's risk for an infection.…”

Section: Discussionmentioning

confidence: 89%

Surgical treatment of the bony mallet thumb: a case series and literature review

Kastenberger

Kaiser

Benedikt

et al. 2022

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method. Patients and methods All patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles). Results Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods. Conclusion The evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.

show abstract

“…Similarly, transverse fractures do not allow for lag screw fixation. This calls to question prior comparisons between ORIF and CRPP strategies, 25,26 in which fracture pattern may have confounded any advantages observed with either fixation strategy. The potential for confounding is likely intensified in direct comparisons of ORIF-plate to CRPP, as the underlying fracture patterns are often inherently different.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Henry

Tulipan

Kwan

et al. 2021

Hand (New York, N,Y.)

View full text Add to dashboard Cite

Background Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. Methods All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. Results Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. Conclusions Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.

show abstract

Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures

Cited by 19 publications

References 26 publications

Controlled active exercise after open reduction and internal fixation of hand fractures

Controlled active exercise after open reduction and internal fixation of hand fractures

Surgical treatment of the bony mallet thumb: a case series and literature review

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Contact Info

Product

Resources

About