Bridge Plating of a First Proximal Phalanx Intra-articular Base Fracture-Benefits Over External Fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Intra-articular fractures of the proximal phalanx base of the thumb can be challenging to manage.
• Severe comminution and poor bone stock present significant treatment difficulties.

Observation:

• A 62-year-old male sustained a comminuted intra-articular proximal phalanx base fracture of the right thumb.
• Computed tomography (CT) demonstrated severe comminution, apex volar angulation, and minimal bone stock.

Findings:

• The patient underwent open reduction internal fixation using a locking plate and cancellous bone grafting.
• Hardware removal at 8 weeks was uncomplicated.
• At 19 weeks post-surgery, metacarpophalangeal joint motion was 10°-30° and interphalangeal motion was 30°-50°, with radiographic evidence of fracture union and proper alignment.

Implications:

• Bridge plating may serve as a viable alternative to external fixation for specific thumb fractures.
• This approach can maintain alignment and articular congruity, potentially allowing earlier return to daily activities.
• Bridge plating may mitigate the risk of pin-track infections associated with external fixation.