Internal fixation of phalangeal fractures using titanium miniplates

Although widely utilized in the treatment of metacarpal fractures, plate fixation in phalangeal fractures remains controversial. Increased potential for infection, breakage, and added soft-tissue trauma leading to increased joint stiffness have been cited as important negative factors. A retrospective analysis of titanium plate fixation of phalangeal fractures over a 7-year period is presented. From 1991 to 1998, 16 fractures (13 men, 3 women; age range, 19-70 years) were managed with plate fixation using the Profyle titanium plating system as the primary modality of treatment. All plates were seated dorsally using an extensor tendon-splitting approach. The average follow-up period after surgery was 5 months (range, 3-28 months). Fracture patterns varied: 31% (5 of 16) were open fractures and 69% (11 of 16) were closed. Complications occurred in 25% of patients (4 of 16) and consisted of pain or other trigger that required removal of hardware, flexion contracture at the proximal interphalangeal joint, and extensor lag. There were no instances of hardware failure, infection, or malunion. The quality of recovery of joint motion was assessed using the Total Active Flexion Scale: nine digits were graded excellent, another six were categorized as good, and only one digit was judged as poor. A review of the current literature is presented along with suggested guidelines for the application of miniplate fixation for fractures of the phalanges.