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. 2023 Jan;18(1):48-54.
doi: 10.1177/15589447211003185. Epub 2021 Apr 9.

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Tyler W Henry  1 , Jacob E Tulipan  2 , Stephanie A Kwan  3 , Pedro K Beredjiklian  2 , Kevin F Lutsky  2 , Jonas L Matzon  2
Affiliations

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Tyler W Henry et al. Hand (N Y). 2023 Jan.

Abstract

Background: Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery.

Methods: All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up.

Results: Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies.

Conclusions: Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.

Keywords: diagnosis; finger; fracture/dislocation; hand; research and health outcomes; trauma; treatment.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
An oblique extra-articular ring finger proximal phalanx fracture.
Figure 2.
Figure 2.
An oblique extra-articular fracture of the small finger proximal phalanx treated with closed-reduction percutaneous pinning.
Figure 3.
Figure 3.
An oblique extra-articular fracture of the index finger proximal phalanx treated with open-reduction internal fixation-screws.
Figure 4.
Figure 4.
Mean PIP extension stratified by affected finger. Kruskal-Wallis H testing level of significance = .155. Note. PIP = proximal interphalangeal.
See this image and copyright information in PMC

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