Plate fixation of extra-articular fractures of the proximal phalanx: do new implants cause less problems?

Brei-Thoma, Pascale Bernadette; Vögelin, Esther; Franz, Torsten (2015). Plate fixation of extra-articular fractures of the proximal phalanx: do new implants cause less problems? Archives of orthopaedic and trauma surgery, 135(3), pp. 439-445. Springer 10.1007/s00402-015-2155-4

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BACKGROUND Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems. METHODS From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS). RESULTS No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total active finger motion (TAM) averaged 183°, and all 32 patients underwent formal hand therapy. At the latest follow-up or at the time of plate removal, respectively, the mean TAM improved to 213°. Extension lag of proximal interphalangeal joints was found in 67 % of all fractured fingers. Secondary surgery was necessary in 14 of 32 patients (2 corrective osteotomies, 12 plate removals including 7 procedures explicitly because of reduced mobility). CONCLUSIONS Despite of new implant designs significant problems persist. Adhesions of extensor tendons leading to limited range of finger motion are still the most frequent complications after ORPF of proximal phalangeal fractures, even in absence of significant soft-tissue damage. LEVEL OF EVIDENCE Therapeutic, Retrospective, Level IV.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Mu50 > Forschungsgruppe Handchirurgie
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Hand Surgery

UniBE Contributor:

Brei-Thoma, Pascale Bernadette; Vögelin, Esther and Franz, Torsten

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0936-8051

Publisher:

Springer

Language:

English

Submitter:

Veronika Picha

Date Deposited:

27 Jul 2015 16:33

Last Modified:

29 Feb 2016 14:07

Publisher DOI:

10.1007/s00402-015-2155-4

PubMed ID:

25577241

BORIS DOI:

10.7892/boris.70383

URI:

https://boris.unibe.ch/id/eprint/70383

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