In-Depth Oral Presentations and Oral Communications IN-DEPTH ORAL PRESENTATIONS AT05–HAND AND WRIST Treatment of malunion of the proximal phalangeal fractures

Introduction It is difficult to treat fractures of the phalanges of the hand because they can cause complications such as deformity and joint limitation with a reduction in the grasping function. The most frequent complications are malunion of the fracture and joint limitation. The greatest incidence of complications can be found in transverse fractures of the base of the proximal phalanx, in articular fractures, comminuted fractures, and in those associated with lesions of the soft tissues. Materials and methods In this paper, we describe the clinical and radiographic results obtained in 20 patients (for a total of 24 fingers) treated surgically to correct the malunion of a fracture of the proximal phalanx of the hand. The patients (16 male and 4 female) were operated on at a mean of 40 days after the initial treatment. A corrective osteoclasia was done within 25 days after initial treatment in 10 cases. In the other 14 cases we performed a corrective osteotomy. Patients were followed-up clinically and radiologically evaluating the deformity correction, the range of motion and grip strength of the hand, and the patient’s degree of satisfaction. We also evaluated functional results by DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results At a mean follow-up of 24 months after surgery, we obtained a correction of the deformity in all patients. An improvement of about 30 % in the range of motion of the PIP was observed. Four patients complained about pain at the maximum degrees of articular excursion of the MP and PIP joints. All the patients presented an improvement in the grip strength of the hand. The mean DASH score in our series was 5 points. X-rays showed that all osteoclasia-osteotomies performed healed within 8 weeks. In 4 cases of articular incongruency, X-rays showed no signs of osteoarthritis in the PIP joint. Discussion The main cause of complications of phalangeal fractures of the hand is the choice of an unsuitable treatment, subsequent to a mistaken clinical and radiographic assessment of the factors that can influence the result of treatment, such as localization, geometry, and stability of the fracture and the presence of associated soft tissue lesions. Conclusions Immediate surgical treatment of articular and periarticular unstable fractures of the proximal phalanx is advised to achieve a stable synthesis and an early mobilization of the MP and IP joints. However, if a malunion is present, it has to be corrected surgically as soon as possible.