Implantation of a denaturated cellulose adhesion barrier after plate osteosynthesis of finger proximal phalangeal fractures: results of a randomized controlled trial
Restricted accessResearch articleFirst published online May, 2016
Implantation of a denaturated cellulose adhesion barrier after plate osteosynthesis of finger proximal phalangeal fractures: results of a randomized controlled trial
Adhesions after osteosynthesis of finger proximal phalangeal fractures often cause stiffness. To minimize adhesions, the use of an adhesion barrier has been proposed. The results until now have not been convincing. The aim of this prospective randomized trial was to evaluate the use of an adhesion barrier. The trial included any isolated, closed proximal phalangeal fracture needing plate osteosynthesis. The patients were randomized into two groups: with or without application of the adhesion barrier. The outcomes we measured were finger ranges of motion and DASH score at 6 weeks and 6 months post-operatively. A total of 42 patients (42 fingers) entered the study; 37 completed the study. The key baseline characterisitcs were comparable. At 6 weeks there was a trend favouring the adhesion barrier that disappeared at 6 months. Overall the results do not support the use of this device.
BeekmanRAAbbotAETaylorNL. Extensor mechanism slide for the treatment of proximal interphalangeal joint extension lag: an anatomic study. J Hand Surg Am. 2004, 29: 1063–8.
2.
BoyerJSLondonDAStepanJG. Pediatric proximal phalanx fractures: outcomes and complications after the surgical treatment of displaced fractures. J Pediatr Orthop. 2015, 35: 219–23.
3.
CutrightDEReidRL. A biodegradable tendon gliding device. Hand. 1975, 7: 228–37.
4.
DiamondMPLinskyCBCunninghamT. Adhesion reformation: reduction by the use of interceed (TC7) plus heparin. J Gynecologic Surg. 1991, 7: 1–6.
EberlinKRBabushkinaANeiraJR. Outcomes of closed reduction and periarticular pinning of base and shaft fractures of the proximal phalanx. J Hand Surg Am. 2014, 39(8): 1524–8.
7.
EgloffCSproedtJJandaliAR. Results after osteosynthesis of extraarticular proximal phalangeal fractures. Handchir Mikrochir Plast Chir. 2012, 44: 5–10.
8.
FranzTJandaliARJungFJ. Functional-conservative treatment of extra-articular physeal fractures of the proximal phalanges in children and adolescents. Eur J Pediatr Surg. 2013, 23: 317–21.
9.
FranzTWartburgUvHugU. Extraarticular proximal phalangeal fractures of the hand: functional conservative management using the Lucerne Cast (LuCa) – a preliminary prospective study. Handchir Mikrochir Plast Chir. 2010, 42: 293–8.
10.
GastonRGChadderdonC. Phalangeal fractures: displaced/nondisplaced. Hand Clin. 2012, 28: 395–401.
11.
GiddinsGE. The non-operative management of hand fractures. J Hand Surg Eur. 2015, 40(1): 33–41.
12.
GoorensCKVan HoonackerPKerckhove. Treatment of fractures of the proximal phalanx of long fingers with an isometric traction splint.Acta Orthop Belg. 2012; 78:473–8.
13.
HenryM. Soft tissue sleeve approach to open reduction and internal fixation of proximal phalangeal fractures. Tech Hand Up Extrem Surg. 2008a, 12: 161–5.
14.
HenryMH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008b, 16: 586–95.
15.
IkedaMKobayashiYSaitoI. Open reduction and internal fixation for dorsal fracture dislocations of the proximal interphalangeal joint using a miniplate. Tech Hand Up Extrem Surg. 2011, 15: 219–24.
16.
ItaderaEHimenoD. Application of a trans-web approach to plating technique for an extra-articular fracture of the proximal phalanx. J Hand Surg. 2013, 18: 129–31.
17.
ItaderaEMuramatsuYShibayamaM. Trans-web approach for fixation of avulsion fractures of the proximal phalangeal base: report of two cases. J Hand Surg Am. 2010, 35: 412–4.
18.
JupiterJBHastingsH2ndCapoJT. The treatment of complex fractures and fracture-dislocations of the hand. Instr Course Lect. 2010, 59: 333.
19.
KangYCTanPL. Simple surgery to improve flexion deficit resulting from mal-union of fracture neck of the proximal phalanx – a case report. J Hand Surg. 2014, 19(1): 123–5.
20.
KhannaAFrielMGougouliasN. Prevention of adhesions in surgery of the flexor tendons of the hand: what is the evidence?Brit Med Bull. 2009, 90:85–109.
21.
KurzenPFusettiCBonaccioMNagyL. Complications after plate fixation of phalangeal fractures. J Trauma. 2006, 60: 841–3.
22.
MeislinRJWisemanDMAlexanderH. A biomechanical study of tendon adhesion reduction using a biodegradable barrier in a rabbit model. J Appl Biomater. 1990, 1: 13–9.
23.
NambaJShimadaKSaitoM. Modulation in peritendinous adhesions by alginate. J Biomed Mater Res B Appl Biomater. 2007, 80: 273–9.
OmokawaSFujitaniRDohiY. Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system. J Hand Surg. 2008, 33: 857–63.
26.
PinkertonMC. Amnioplastin for adherent digital flexor tendons. The Lancet. 1942: 239: 70–72.
27.
SahinFYücelSDYilmazF. Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures. Acta Orthop Traumatol Turc. 2006, 40: 274–9.
28.
SeoBFKimDJLeeJY. Minimally invasive correction of phalangeal malunion under local anaesthesia. Acta Orthop Belg. 2013, 79: 592–5.
29.
SinghJJainKMruthyunjayaRavishankar R. Outcome of closed proximal phalangeal fractures of the hand. Indian J Orthop. 2011, 45:432–8.
30.
StarkHHBoyesJHJohnsonL. The use of paratenon, polyethylene film or silastic sheeting to prevent restricting adhesions to tendons in the hand. J Bone Joint Surg Am. 1977, 59: 908–13.
31.
TangJBAvanessianB. Clinical reports: the importance of reporting a surgeon’s level of expertise. J Hand Surg Am. 2015, 40: 416–7.
32.
TemizAOzturkCBakunovA. A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier. Int Orthop. 2008, 32: 389–94.
33.
ThomineJMGibonYBendjeddouMS. Functional brace in the treatment of diaphyseal fractures of the proximal phalanges of the last four fingers. Ann Chir Main. 1983; 2: 298–306.
34.
WeissCLevyHJDenlingerJ. The role of Na-hylan in reducing postsurgical tendon adhesions. Bull Hospital for Joint Diseases, Orthopaedic Institute. 1986, 46: 9–15.
35.
WheeldonT. The use of cellophane as a permanent tendon sheat, J Bone Joint Surg. 1939, 21: 393–6.
36.
WilliamsCWDickieWRColvilleJ. Silastic sheeting in hand surgery. The Hand. 1972, 4(3): 273–276.
37.
YanYMZhangWPLiaoY. Analysis and prevention of the complications after treatment of metacarpal and phalangeal fractures with internal fixation. Zhongguo Gu Shang. 2011, 24: 199–201.
