Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: a prospective study

Abstract

We prospectively assessed clinical and radiological outcomes of locking plate fixation in treating unstable fractures in 11 metacarpals, 15 proximal phalanges, and eight middle phalanges in 34 consecutive patients from October 2011 to December 2016. Median length of follow-up was 14 months (range 12–24). The motion of finger joints, bony union, and complication rates were recorded. The median postoperative range of motion of the two interphalangeal joints and the metacarpophalangeal joint was 82% of the contralateral hands. Fractures in the three locations had significantly different recovery of the finger motion, with the best recovery for the metacarpal fractures. Closer distance between the plate edge and joint line was associated with a more limited range of the finger motion. The clinical outcomes approached an acceptable level at final follow-up. Finger stiffness is unavoidable after locking plate fixation of metacarpal and phalangeal fractures even with early hand therapy, with stiffness occurring in 10 out of 34 cases at the time of final follow-up 1 year after surgery.

Level of evidence: II

Keywords

Metacarpal fracture phalangeal fracture locking plate fixation clinical outcome

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References

Bosscha

Snellen

. Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study. Injury. 1993, 24: 166–8.

Bernstein

Chung

. Hand fractures and their management: an international view. Injury. 2006, 37: 1043–8.

Dionysian

Kabo

Dorey

Meals

. Proximal interphalangeal joint stiffness: measurement and analysis. J Hand Surg Am. 2005, 30: 573–9.

Duncan

Freeland

Jabaley

Meydrech

. Open hand fractures: an analysis of the recovery of active motion and of complications. J Hand Surg Am. 1993, 18: 387–94.

El-Saeed M, Sallam A, Radwan M, Metwally A. Kirschner wires versus titanium plates and screws in management of unstable phalangeal fractures: a randomized controlled clinical trial. J Hand Surg Am. 2019, 44: 1091.e1–1091.e9.

Faruqui

Stern

Kiefhaber

. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am. 2012, 37: 1342–8.

Handschin

Cardell

Contaldo

Trentz

Wanner

. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008, 39: 306–13.

Heller

Manuguerra

Chow

. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain. 2016, 13: 67–75.

Hsu

Schwartz

Kalainov

Chen

Makowiec

. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am. 2011, 36: 610–6.

10.

Kurzen

Fusetti

Bonaccio

Nagy

. Complications after plate fixation of phalangeal fractures. J Trauma. 2006, 60: 841–3.

11.

Lee MA. Techniques of absolute stability. In: Buckley RE, Moran CG, Apivatthakakul T (Eds.) AO principles of fracture management, 3rd Ed. New York, Thieme, 2018, Vol.1: 185–208.

12.

Omokawa

Fujitani

Dohi

Okawa

Yajima

. Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system. J Hand Surg Am. 2008, 33: 857–63.

13.

Onishi

Omokawa

Shimizu

Fujitani

Shigematsu

Tanaka

. Predictors of postoperative fingers stiffness in unstable proximal phalanges fractures. Plast Reconstr Surg Glob Open. 2015, 3: e431.

14.

Orbey

Fernandez

. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002, 27: 205–15.

15.

Page

Stern

. Complication and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998, 23: 827–32.

16.

Shimizu

Omokawa

Akahane

, et al. Predictors of the postoperative range of finger motion for comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate. Injury. 2012, 43: 940–5.

17.

Suzuki

Kurimoto

Shinohara

, et al. Development and validation of an illustrated questionnaire to evaluate disabilities of the upper limb. J Bone Joint Surg Br. 2010, 92: 963–9.

18.

Tang

Giddins

. Why and how to report surgeon’s levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.

19.

Takigami

Sakano

Saito

. Internal fixation with the low profile plate system compared with Kirschner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures. Hand Surg. 2010, 15: 1–6.

20.

Tejwani

Murthy

Park

McLaurin

Egol

Kummer

. Fixation of extra-articular distal humerus fractures using one locking plate versus two reconstruction plates: a laboratory study. J Trauma. 2009, 66: 795–9.

21.

Van Onslen

Karim

Hage

Ritt

. Prevalence and distribution of hand fractures. J Hand Surg Br. 2003, 28: 491–5.

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