Implantation of a denaturated cellulose adhesion barrier after plate osteosynthesis of finger proximal phalangeal fractures: results of a randomized controlled trial

Abstract

Adhesions after osteosynthesis of finger proximal phalangeal fractures often cause stiffness. To minimize adhesions, the use of an adhesion barrier has been proposed. The results until now have not been convincing. The aim of this prospective randomized trial was to evaluate the use of an adhesion barrier. The trial included any isolated, closed proximal phalangeal fracture needing plate osteosynthesis. The patients were randomized into two groups: with or without application of the adhesion barrier. The outcomes we measured were finger ranges of motion and DASH score at 6 weeks and 6 months post-operatively. A total of 42 patients (42 fingers) entered the study; 37 completed the study. The key baseline characteristics were comparable. At 6 weeks there was a trend favouring the adhesion barrier that disappeared at 6 months. Overall the results do not support the use of this device.

DendroPrime as an adhesion barrier on fracture fixation plates: an experimental study in rabbits

“…A study in hand surgery related to the reduction of adhesions after fracture surgery was published by Kappos et al (2016). The anti-adhesional effect of a methyl cellulose barrier seen at 6 weeks postoperatively had disappeared at 6 months due to degradation of the product.…”

“…Adhesion barriers have previously been tested in hand surgery; however, these studies have mostly focused on flexor tendon injury models (Golash et al, 2003;Hagberg and Gerdin, 1992;Hakansson et al, 2012;Lees et al, 2015;Wiig et al, 2011). Kappos et al (2016) reported on the use of an adhesion barrier in fracture surgery using a cellulose membrane to cover phalangeal plates with short term positive effects.…”

Proximal Phalanx Fracture Management

“…Unlike K-wires which are removed at 3 to 4 weeks, screws and plates are intended to remain in place and may directly result in finger stiffness related to adhesions between the hardware and the extensor mechanism. 21 Therefore, any hardware that is unnecessarily large or has sharp edges, such as prominent screw heads or a plate, will inevitably lead to mechanical irritation and increased inflammation. 25…”

“…An adhesion barrier between the plate and the soft tissues has been postulated to reduce friction when using a dorsal plate. 21 A double-blinded randomized controlled trial showed mean motion and Disabilities of the Arm, Shoulder, and Hand values to be slightly better for the barrier group at 6 weeks, although not statistically significant, and this trend disappeared by 6 months.…”

“…2,23,28 Adhesions may occur between the tendon and implant 7,23,30 and are not due only to mechanical friction but also secondary to a foreign body soft tissue response. 21,25 The implant material may not play a large role in the formation of stiffness as both stainless steel and titanium implants have been associated with increased inflammation. 5,16 Precontoured plates have a potential benefit of reducing the risk of tendon irritation.…”