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. 2015 Jul 8;3(6):e431.
doi: 10.1097/GOX.0000000000000396. eCollection 2015 Jun.

Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures

Tadanobu Onishi  1 , Shohei Omokawa  1 , Takamasa Shimizu  1 , Ryotaro Fujitani  1 , Koji Shigematsu  1 , Yasuhito Tanaka  1
Affiliations

Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures

Tadanobu Onishi et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The purpose of this study was to determine the risk factors for postoperative finger stiffness after open reduction and internal fixation of unstable proximal phalangeal fractures using a low-profile plate and/or screw system. We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness.

Methods: Seventy consecutive patients (50 men, 20 women; average age, 40 years) with 75 unstable proximal phalangeal fractures were treated with titanium plates and/or screws and evaluated at a minimum follow-up of 1 year. Thirty-six comminuted fractures and 24 intra-articular fractures were included, and 16 fractures had associated soft-tissue injuries. Plate fixation was performed in 59 fractures, and the remaining 16 were fixed with screws only. The implants were placed in a dorsal location in 33 fractures and in a lateral or volar location in 42 fractures. Finger stiffness was defined as a total active range of finger motion <80% for the treated finger. Univariate and multivariate analyses were performed on 8 variables: patient characteristics (age and sex), fracture characteristics (fracture comminution, joint involvement, and associated soft-tissue injury), and surgical characteristics (type and location of implants and removal of the implants).

Results: Postoperative finger stiffness occurred in 38 fractures. The multivariate analysis indicated that plate fixation (odds ratio, 5.9; 95% confidence interval, 1.5-24.0; P = 0.01) and dorsal placement (odds ratio, 3.0; 95% confidence interval, 1.1-8.3; P = 0.03) were independent risk factors for finger stiffness.

Conclusion: We recommend the use of screw fixation as much as possible for unstable proximal phalangeal fractures using a midlateral approach.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Figures

Fig. 1.
Fig. 1.
Case 1: A simple oblique fracture of the proximal phalanx in the left little finger of a 17-year-old boy. Preoperative and postoperative radiographs.
Fig. 2.
Fig. 2.
Case 1: Intraoperative photograph and finger motion at the final follow-up.
Fig. 3.
Fig. 3.
Case 2: A comminuted intra-articular fracture of the unicondylar proximal phalangeal phalanx in the index finger of a 17-year-old boy. Preoperative radiograph and computed tomography image.
Fig. 4.
Fig. 4.
Case 2: Fixation with a 1.5-mm T-plate laterally (A) and a postoperative radiograph after the implant removal procedure (B).
Fig. 5.
Fig. 5.
Case 2: Finger motion at the final follow-up.
See this image and copyright information in PMC

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