Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures

Objectives: We evaluated the functional results and the ef¬fectiveness of open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Methods: The study included 17 patients (5 women, 12 men; mean age 33±10 years; range 17 to 48 years) with closed, non- articular phalangeal fractures. One patient had two phalangeal fractures. There were 14 proximal and four mid phalangeal frac¬tures, including seven oblique, four spiral, one transverse, and six comminuted fractures. The mean duration f rom injury to surgery was 2.6±2.9 days (range 0 to 11 days). Following open reduction, seven fractures were treated with a mini plate and screws, and 11 fractures with mini screws. For functional evaluations, total active motion (TARM) and grip strength were measured and the Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) questionnaire was administered. The mean follow-up was 35±20 months (range 12 to 75 months). Results: Union was obtained in all the patients in a mean of 4.5 months. At final assessments, TARM ranged from 160° to 260° (mean 200±39.5°), showing excellent, good, and moder¬ate results in six fingers (33.3%), five fingers (27.8%), and seven fingers (38.9%), respectively. An excellent or good TARM was obtained in eight fingers (72.2%) treated with mini screws, and in three fingers (42.9%) treated with plate-screw fixation. The mean grip strength decreased by 7.5% (range 0 to 20%) on the affected side. The mean Q-DASH score was 3.4±4.4. Accord¬ing to the classification of complications proposed by Page and Stern, seven major (38.9%) and six minor (33.3%) complications were seen. Two patients (11.1%) had delayed union. Conclusion: Our findings do not justify open reduction and low-profile plate and/or screw fixation as the first choice in the treatment of phalangeal fractures. If plate and screw fixa¬tion is necessary, the most minimally invasive method such as screw fixation should be preferred.