Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures

Abstract

Background:The purpose of this study was to determine the risk factors for postoperative finger stiffness after open reduction and internal fixation of unstable proximal phalangeal fractures using a low-profile plate and/or screw system. We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness.Methods:Seventy consecutive patients (50 men, 20 women; average age, 40 years) with 75 unstable proximal phalangeal fractures were treated with titanium plates and/or screws and evaluated at a minimum follow-up of 1 year. Thirty-six comminuted fractures and 24 intra-articular fractures were included, and 16 fractures had associated soft-tissue injuries. Plate fixation was performed in 59 fractures, and the remaining 16 were fixed with screws only. The implants were placed in a dorsal location in 33 fractures and in a lateral or volar location in 42 fractures. Finger stiffness was defined as a total active range of finger motion <80% for the treated finger. Univariate and multivariate analyses were performed on 8 variables: patient characteristics (age and sex), fracture characteristics (fracture comminution, joint involvement, and associated soft-tissue injury), and surgical characteristics (type and location of implants and removal of the implants).Results:Postoperative finger stiffness occurred in 38 fractures. The multivariate analysis indicated that plate fixation (odds ratio, 5.9; 95% confidence interval, 1.5–24.0; P = 0.01) and dorsal placement (odds ratio, 3.0; 95% confidence interval, 1.1–8.3; P = 0.03) were independent risk factors for finger stiffness.Conclusion:We recommend the use of screw fixation as much as possible for unstable proximal phalangeal fractures using a midlateral approach.

Proximal Phalanx Fracture Management

“…Retracting the extensor mechanism instead of surgically splitting it optimizes extensor mechanism function and minimizes scarring. 26 Fixation under the extensor tendon is to be avoided; if unavoidable, screws should be countersunk to minimize friction. 18,27 Radial or ulnar midaxial positions beginning distal to the lateral bands and ending proximal to the collateral ligaments of the PIP joint represent an ideal location to avoid friction between the hardware and the mobile extensor tendon.…”

“…18,27 Radial or ulnar midaxial positions beginning distal to the lateral bands and ending proximal to the collateral ligaments of the PIP joint represent an ideal location to avoid friction between the hardware and the mobile extensor tendon. 26,27 If need be, 2 plates can be placed on both radial or ulnar sides and the lateral bands can be partially excised to facilitate more proximal plate placement.…”

“…Seventy-five unstable proximal phalanx fractures were treated with titanium plates and screws in 59 fractures and with screws only in 16 fractures. 26 Fixation was dorsal in 33 fractures and lateral in 42 fractures. Multivariate logistic model analysis of TAM showed increased finger stiffness was associated with plate and screw fixation versus screw only fixation, as well as with dorsal versus lateral plate placement.…”

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

“…Open reduction and plate fixation of phalangeal fractures often results in adhesion formation and finger stiffness (Brei-Thoma et al, 2015;Egloff et al, 2012;Kurzen et al, 2006;Onishi et al, 2015;Page and Stern, 1998;von Kieseritzky et al, 2017). The short distance between bone and tendons is further reduced by the osteosynthesis materials, and overgrowth of callus can also affect tendon gliding (Brei-Thoma et al, 2015).…”

A technique for K-wire assisted closed reduction and percutaneous screw fixation of phalangeal fractures

“…Following open reduction and internal fixation of finger fractures, postoperative stiffness is a potential problem, occurring in up to 51% of cases. 1 Stiffness can be significantly reduced by using closed reduction and Kirschner wire (K-wire) fixation, 2 although infection is a problem reportedly occurring in up to 18% of cases. 3 We describe a simple method for phalangeal fracture (Fig 1) fixation.…”