Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures

Abstract

Objectives: We evaluated the functional results and the effectiveness of open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Methods: The study included 17 patients (5 women, 12 men

mean age 33 +/- 10 years

range 17 to 48 years) with closed, non-articular phalangeal fractures. One patient had two phalangeal fractures. There were 14 proximal and four mid phalangeal fractures, including seven oblique, four spiral, one transverse, and six comminuted fractures. The mean duration from injury to surgery was 2.6 +/- 2.9 days (range 0 to 11 days). Following open reduction, seven fractures were treated with a mini plate and screws, and 11 fractures with mini screws. For functional evaluations, total active motion (TARM) and grip strength were measured and the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire was administered. The mean follow-up was 35 20 months (range 12 to 75 months). Results: Union was obtained in all the patients in a mean of 4.5 months. At final assessments, TARM ranged from 160 degrees to 260 degrees (mean 200 +/- 39.5 degrees), showing excellent, good, and moderate results in six fingers (33.3\%), five fingers (27.8\%), and seven fingers (38.9\%), respectively. An excellent or good TARM was obtained in eight fingers (72.2\%) treated with mini screws, and in three fingers (42.9\%) treated with plate-screw fixation. The mean grip strength decreased by 7.5\% (range 0 to 20\%) on the affected side. The mean Q-DASH score was 3.4 +/- 4.4. According to the classification of complications proposed by Page and Stern, seven major (38.9\%) and six minor (33.3\%) complications were seen. Two patients (11.1\%) had delayed union. Conclusion: Our findings do not justify open reduction and low-profile plate and/or screw fixation as the first choice in the treatment of phalangeal fractures. If plate and screw fixation is necessary, the most minimally invasive method such as screw fixation should be preferred.