Outcome of closed proximal phalangeal fractures of the hand

Indian Journal of Orthopaedics, 08/23/2011

Singh J et al. - Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery, Surgical modalities have distinct advantage of stable fixation, but with added risk of digital stiffness. Percutaneous pinning is a reliable, most commonly used surgical modality and technically easier. Both conservative and surgical modalities have good efficacy when used judiciously.

Methods

  • Eighty-four proximal phalangeal fractures in 68 patients were enrolled from 2007 to 2009.
  • The treatment modalities were broadly categorised into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment.
  • Group A included 47 digits treated with closed reduction (CR) with immobilization (n=43), extension block cast and dynamic traction (n=4), while 37 digits were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=31),
  • OR and IF with stainless-steel wiring (n=2), and mini external-fixator (n=4).
  • Belsky's criteria and Gingrass' criteria were used for assessment of finger injuries and to assess the efficacy of conservative and surgical modalities for closed proximal phalangeal fractures of the hand.

Results

  • Average period of follow-up was 1 year (range 10-14 months).
  • The excellent to good results seen in Groups A and B were 89% and 92%, respectively.
  • Six complications were seen in Group A, which included four cases with malunion and two cases with digital stiffness.
  • Three complications were seen in Group B, which included one each of malunion, digital stiffness and extensor lag.
  • Overall, maximum poor results (n=4) were seen with CR and buddy strapping.

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