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External fixation of open comminuted fractures of the proximal phalanx
R S Smith1, J Alonso, M Horowitz
1Department of Orthopaedic Surgery, University Hospital of Jacksonville, Florida.
Insights
External fixation using the AO/ASIF small external fixator is effective for proximal phalanx fractures, particularly for digit salvage in interphalangeal joint injuries. This method aids in healing and preserving function in complex hand fractures.
Area of Science:
- Orthopedics
- Trauma Surgery
- Hand Surgery
Background:
- External fixation is a recognized treatment for various injuries.
- Limited data exists on its application for open, comminuted hand fractures.
- Proximal phalanx fractures present unique challenges in hand reconstruction.
Purpose of the Study:
- To evaluate the efficacy of the AO/ASIF small external fixator for treating proximal phalanx fractures.
- To assess functional outcomes and complications associated with this fixation method.
- To determine the optimal use of external fixation in complex hand trauma.
Main Methods:
- A retrospective review of eleven proximal phalanx fractures in ten patients treated with AO/ASIF small external fixators.
- Fractures included interphalangeal joint (IPJ), metacarpophalangeal joint (MPJ), and shaft injuries.
- Fixator application varied based on fracture location and joint involvement.
Main Results:
- Successful healing occurred in all shaft fractures, though three required bone grafting.
- IPJ fractures treated with fixators achieved stable ankylosis with functional flexion.
- MPJ motion averaged 75-85 degrees; PIPJ and DIPJ motion varied.
- Complications included pin tract drainage (3/11) and minor reduction loss (2/11).
Conclusions:
- The AO/ASIF small external fixator is a viable option for open, comminuted proximal phalanx fractures.
- It demonstrates particular benefit as a digit salvage procedure for interphalangeal joint fractures.
- Careful application and management are crucial to minimize complications and optimize functional recovery.
Abstract:
External fixation is an accepted method of treatment for many injuries, however, only a limited number of reports concern its use in open, comminuted fractures of the hand. Ten patients with eleven fractures of the proximal phalanx were treated using the AO/ASIF small external fixator. Five fractures involved the interphalangeal joint (IPJ), two the metacarpophalangeal joint (MPJ), and four the shaft. Nine fractures were caused by small caliber gunshot wounds, one was due to a power saw injury, and one occurred during a three wheeler accident. The patients with interphalangeal joint involvement all had extensive involvement of one or both of the joint surfaces. The fixator was placed across the joint and a stable ankylosis allowed to occur with the IPJ in 30 degrees to 40 degrees of flexion. MPJ motion averaged 75 degrees in these patients while distal interphalangeal joint (DIPJ) motion averaged 20 degrees. The four patients with shaft fractures all healed, but three required bone grafting. These patients averaged 85 degrees of MPJ motion, 25 degrees of proximal interphalangeal joint (PIPJ) motion, and 30 degrees of DIPJ motion. One patient with metacarpophalangeal joint involvement regained 85 degrees of MPJ motion but had limited motion at the PIPJ and DIPJ. The other patient with MPJ involvement suffered massive bone loss; a ray amputation was eventually performed. Complications included pin tract drainage in three of the eleven fractures and slight loss of reduction in two fractures. The best clinical results occurred when the fixator was used as a digit salvage procedure in interphalangeal joint fractures.(ABSTRACT TRUNCATED AT 250 WORDS)