Intra-articular fractures of the hand: treatment by open reduction and internal fixation

This study was designed to evaluate the results of open reduction and internal fixation of intra-articular fractures of the hand.

Retrospective review.

Patients were treated at 2 university hospital settings by 2 hand surgeons.

Twenty-eight patients with displaced intra-articular fractures of the hand treated with mini-screw/plate fixation were identified from databases maintained by two hand surgeons. There were 23 men and 5 women, with an average age of 35 (range, 18-68) years.

Titanium mini-plate and screw set was used in all cases.

Total active motion of the digit scored according to the Belsky and Gingrass systems.

Twenty-two patients (79%) had excellent or good results, and 6 patients (21%) had poor results. All 5 thumb fractures healed without complication and had excellent results. For the lesser digits, 9 had excellent, 8 had good, and 6 had poor clinical outcomes. Poor outcomes were identified in patients with comminuted (P = 0.01) or open (P < 0.001) fractures. Other complications included superficial infection and hardware prominence, both of which occurred in patients with distal phalanx dorsal lip fractures (P = 0.01).

Open reduction and internal fixation of articular fractures of the joints of the hand seems to be an effective treatment method for these difficult fracture patterns. We identified excellent or good outcomes in 79% of our patient group. Patients with open or comminuted fractures were found to have poor results.