Analysis of Functional Outcome Following Rigid Skeletal Stabilisation of Unstable Proximal and Middle Phalangeal Fractures of the Hand

Abstract

Introduction: Phalangeal fractures commonly occur in hand injuries. As hand is a complex structure of bones, joints, ligaments, muscles, tendons and neurovascular structures, the biomechanics play an important role in mobility and dexterity of the hand. Operative fixation of these fractures with miniplates and screws allows for earlier mobilisation of the hand and hence avoids the complications of other methods of fracture fixation. This allows for shorter hospital stay and faster returns to work. Aim: This prospective study was undertaken to evaluate and analyse the functional outcome following rigid skeletal stabilisation and early mobilisation of fractures of proximal and middle phalanges of the hand with plate and screw technique. Materials and Methods: There were a total of 21 patients with 26 phalangeal fractures. All the data were collected from Government Chengalpattu Medical College Hospital, Chengalpattu during the period of December 2008 to December 2010. An informed written consent and x-rays of the hand were taken, pre and postoperatively. The fractures were reduced and fixed with miniplates and screws. The results were analysed using the Belsky’s criteria using the parameters of pain with or without union, deformity and total active flexion range of metacarpophalangeal and interphalangeal joints. Results: Among the patients, 84.6% of the fractures showed an excellent or good functional outcome and 15.4% had a poor outcome following rigid skeletal stabilisation. Eighteen (86%) fractures were in male patients, of third to fourth decade, involving mainly the proximal phalanx, due to Road Traffic Accident (RTA), with six patients having complications. Conclusion: Phalangeal fracture fixation with miniplates and screws gives a good functional outcome.

Keywords

• fracture
• function
• plate and screw fixation
• total active motion