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

Abstract

A 62-year-old right-handed man presented with an intra-articular fracture of the proximal phalanx base of the right thumb after a motor vehicle accident. Computed tomography revealed severe comminution, apex volar angulation, and minimal bone stock at the proximal phalanx base. The patient consented to open reduction internal fixation with a locking plate to bridge the fracture and cancellous bone grafting of the distal radius. The hardware was removed at 8 weeks, without complications. The patient began therapy, and at 19 weeks following the surgery, the patient's thumb metacarpophalangeal joint motion was 10° to 30° and the interphalangeal motion was 30° to 50°. Radiographs showed fracture union and proper alignment, with modest shortening. The patient was satisfied with this result. Bridge plating may be an alternative to external fixation for certain thumb fractures, with the potential to maintain alignment and articular congruity while permitting earlier return to activities of daily living and avoiding the risk of pin-track infections.

Keywords: Bridge plate; External fixation; Intra-articular fracture; Metacarpophalangeal joint; Proximal phalanx.

Figure 1

Preoperative hand x-rays—A posteroanterior, B oblique, and C lateral views—demonstrated a first proximal phalanx base fracture with comminution.

Figure 2

Preoperative hand computed tomographic scans—A sagittal and B coronal views—demonstrated comminution with minimal bone stock at the base of the first proximal phalanx.

Figure 3

A and B Preoperative 3-dimensional computed tomographic reconstruction of the first proximal phalanx further demonstrated extension into the MCP joint, comminution, and lack of proximal bone stock.

Figure 4

Intraoperative fluoroscopy, A posteroanterior and B lateral views, demonstrated successful application of bridge plates.

Figure 5

A Posteroanterior and B lateral hand x-rays after plate removal, 9 weeks after the initial operation, demonstrated preservation of joint congruity, fracture stability, and bony geometry.

Figure 6

A Posteroanterior and B lateral x-rays 14 weeks after surgery demonstrated healing fracture union, with some fracture collapse, compared with the previous set of images.