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Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures.

Onishi T, Omokawa S, Shimizu T, Fujitani R, Shigematsu K, Tanaka Y - Plast Reconstr Surg Glob Open (2015)

Bottom Line: We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

Case 1: Intraoperative photograph and finger motion at the final follow-up.
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Figure 2: Case 1: Intraoperative photograph and finger motion at the final follow-up.

Mentions: Based on the present multivariate analysis, we recommend the use of screw fixation where possible for unstable proximal phalangeal fractures using a midlateral approach (Figs. 1, 2). In cases with transverse or comminuted fractures, which are difficult fractures to fix with screws alone, lateral plate fixation is recommended (Figs. 3–5). We agree with Jones et al12 that lateral plate fixation prevents interference with gliding of the overlying extensor tendon.5 In addition, a biomechanical study indicated that the mechanical properties of the proximal phalanx after lateral plate fixation were comparable with those after dorsal plate fixation.13


Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures.

Onishi T, Omokawa S, Shimizu T, Fujitani R, Shigematsu K, Tanaka Y - Plast Reconstr Surg Glob Open (2015)

Case 1: Intraoperative photograph and finger motion at the final follow-up.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494501&req=5

Figure 2: Case 1: Intraoperative photograph and finger motion at the final follow-up.
Mentions: Based on the present multivariate analysis, we recommend the use of screw fixation where possible for unstable proximal phalangeal fractures using a midlateral approach (Figs. 1, 2). In cases with transverse or comminuted fractures, which are difficult fractures to fix with screws alone, lateral plate fixation is recommended (Figs. 3–5). We agree with Jones et al12 that lateral plate fixation prevents interference with gliding of the overlying extensor tendon.5 In addition, a biomechanical study indicated that the mechanical properties of the proximal phalanx after lateral plate fixation were comparable with those after dorsal plate fixation.13

Bottom Line: We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.

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.

No MeSH data available.


Related in: MedlinePlus