Malunion and Nonunion of the Metacarpals and Phalanges

Ring, David

doi:10.2106/00004623-200506000-00028

Cited by 33 publications

(41 citation statements)

References 18 publications

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“… 10 – 16 The advantages of in situ phalangeal osteotomy are that it can address other concomitant phalangeal deformities and provide the opportunity to perform tenocapsulolysis. 17 However, phalangeal osteotomy carries the risk of inadvertent intraoperative injury and requires more time for bone healing. 4 , 17 The technical ease of performing the procedure and the fact that there is no need to expose the phalangeal malunion site are the advantages of metacarpal osteotomy.…”

Section: Discussionmentioning

confidence: 99%

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

Abe

2015

Plastic and Reconstructive Surgery - Global Open

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Background:The theory that malrotation is best assessed by making a fist and looking for digital overlap was the basis for devising a simple, easy, and reliable technique for phalangeal corrective osteotomy.Methods:This study assessed the phalangeal corrective osteotomy technique in 7 digits, involving 7 cases in 6 patients; 1 patient required treatment bilaterally. This technique required the use of a small hologram 2-row plate and screws to maintain stable fixation during aggressive postoperative therapy. Evaluation of the clinical results was based on the total range of active motion (%TAM), the grading of results according to Büchler, and the severity of pain reported by patients using the visual analog scale. The disability of the arm, shoulder, and hand questionnaire was completed preoperatively and at final follow-up by patients.Results:Corrective osteotomy corrected the overlapping of digits in all of the patients. There were no perioperative complications. Bone union was obtained in all cases, on average 13.4 weeks after surgery. Two osteotomies required secondary tenocapsulolysis concomitant with implant removal surgery. In light of total range of active motion and Büchler’s grade, all the patients had excellent to good results for both criteria at final follow-up. No patient complained about pain. Mean disability of the arm, shoulder, and hand scores significantly decreased from 16.9 (range, 11.3–26.5) preoperatively to 3.9 (range, 0–7.6) postoperatively.Conclusions:Phalangeal corrective osteotomy was performed using a simple, easy, and reliable technique.

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Section: Discussionmentioning

confidence: 99%

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

Abe

2015

Plastic and Reconstructive Surgery - Global Open

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“…However, when a severe articular malunion is associated with early osteoarthritis of the MP joint, the treatment of choice is an arthrodesis or an arthroplasty [14]. …”

Section: Discussionmentioning

confidence: 99%

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

Potenza¹,

Luna²,

Maglione³

et al. 2012

TOORTHJ

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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.

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“…En las fracturas complejas con pérdida ósea, la posibilidad de colocar una prótesis de "silastic" tipo Swanson N Figura 9, debe considerarse cuando es posible reconstruir una cobertura cápsulo-ligamentosa adecuada para la misma 42 . En caso contrario, la artrodesis será la técnica de salvamento, aunque con frecuencia, la amputación del dedo lesionado puede ser una alternativa necesaria, especialmente en graves lesiones uni-digitales 43 . Las fracturas bicondíleas habitualmente están desplazadas, siendo necesaria su reducción y osteosíntesis 2 .…”

Section: Clasificaciónunclassified

“…Aun así el resultado en estos casos de seudoartrosis suele ser muy pobre, tanto por rigidez residual importante como por nuevo fracaso del proceso de consolidación. Por ello una opción a valorar en estos casos es la artrodesis de la articulación, e incluso en los casos con grave rigidez y alteraciones tróficas, la amputación del dedo puede ser la opción más recomendable 43,49 .…”

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Fracturas del extremo distal de la falange proximal

Yáñez

Escobar²,

Irisarri³

2014

Rev Iberoam Cir Mano

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Las fracturas de las falanges son en su mayoría estables y por ello susceptibles de tratamiento conservador [1][2][3] . Sin embargo, algunas requieren osteosíntesis tras una reducción cerrada o abierta, dependiendo de su localización, trazo de la fractura, grado de desplazamiento o la coexistencia de lesiones asociadas de partes blandas 3,4 .Las fracturas del extremo distal de la falange son menos frecuentes que las diafisarias, pero su cercanía a la articulación interfalángica proximal (IFP) les confiere un mayor riesgo de secuelas 2 . Podemos dividirlas en fracturas articulares o de la cabeza y extraarticulares o del cuello, aunque en ocasiones, pueden afectar a ambas regiones anatómicas. Por su diferente pronóstico y tratamiento, deben considerarse separadamente las fracturas que ocurren en la edad infantil y las que suceden en el adulto.No son infrecuentes los casos mal valorados inicialmente y por ello tratados de forma inadecuada, derivando en consolidaciones viciosas o seudoartosis. La principal causa es la carencia de un estudio radiológico adecuado 1,5,6 . Dado que en las falanges no existe una dr. Javier yáñez Calvo Servicio de COT. Hospital do Meixoeiro. C/ Meixoeiro snº. 36200. Vigo, Pontevedra. España e.mail: jyanezc@msn.com abstract: Proximal phalanx fractures located on its head or neck are frequently complex and unstable injuries, difficult to manage adequately. Therefore, is not uncommon that complications will happen, like, malunion, nonunion, posttraumatic arthritis or stiffness of the affected fingers. The knowledge of the several types of fractures and their proper diagnosis and treatment are essential to achieve the better possible outcome. We present in this article our experience with these fractures, as well as the literature review on this topic, both in children and in adults, analyzing the different types of fractures, the different treatment modalities, the more frequent related complications and our recommendations to avoid or treat them. Key words:Fractures, head of proximal phalanx, neck of proximal phalanx, malunion, nonunion.resumen: las fracturas del extremo distal de la falange proximal, localizadas en la cabeza o cuello de la misma, son con frecuencia inestables y por su complejidad, suelen ser fracturas difíciles de tratar correctamente. no es por ello infrecuente que se produzcan complicaciones tales como consolidaciones en mala posición, seudoartrosis, artrosis postraumática o rigideces de los dedos afectados. el conocimiento de los distintos patrones de fractura, así como su diagnóstico y tratamiento adecuados, son esenciales para conseguir los mejores resultados posibles. exponemos en este artículo nuestra experiencia con este tipo de lesiones, realizando una revisión de la literatura de las mismas, tanto en niños como en adultos, analizando los diferentes tipos de fracturas, los tratamientos posibles, las complicaciones más frecuentes que hemos observado y nuestras recomendaciones para evitarlas y tratarlas.Palabras clave: Fracturas, cabeza de la falange proximal, cue...

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Malunion and Nonunion of the Metacarpals and Phalanges

Cited by 33 publications

References 18 publications

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

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

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

Fracturas del extremo distal de la falange proximal

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