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

Year 2009, Volume: 43 Issue: 4, 317 - 323, 22.09.2009

Abstract

Objectives: We evaluated the functional results and the effectiveness 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, nonarticular phalangeal fractures. One patient had two phalangeal fractures. There were 14 proximal and four mid phalangeal fractures, including seven oblique, four spiral, one transverse, and six comminuted fractures. The mean duration from 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 moderate 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. According 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 fixation is necessary, the most minimally invasive method such as screw fixation should be preferred.

Falanks kırıklarında açık düzeltme ve mini plak ve/veya vida ile tespit yönteminin yeri

Year 2009, Volume: 43 Issue: 4, 317 - 323, 22.09.2009

Abstract

Amaç: Açık düzeltme ve mini plak ve/veya vida ile tespit uygulanan falanks kırıklarının fonksiyonel sonuçları ve yöntemin etkinliği değerlendirildi.
Çalışma planı: Çalışmaya, eklemi ilgilendirmeyen falanks kırığı olan 17 hasta (5 kadın, 12 erkek; ort. yaş 33±10; dağılım 17-48) alındı. Bir hastada iki parmakta kırık vardı. Kırıkların 14’ü proksimal, dördü orta falankstaydı. Kırıkların yedisi oblik, dördü spiral, biri transvers, altısı parçalı kırık idi. Kırıkların hepsi kapalıydı. Hastalar kırık oluştuktan ortalama 2.6±2.9 gün (dağılım 0-11 gün) sonra ameliyat edildi. Açık redüksiyondan sonra, yedi kırıkta mini plak ve vidalar, 11 kırıkta sadece mini vidalar ile tespit sağlandı. Fonksiyonel sonuçlar için parmaktaki toplam aktif eklem hareket açıklığı (TAEHA) ve kavrama gücü ölçüldü ve Q-DASH (Quick-Disabilities of the Arm, Shoulder and Hand) sorgulaması uygulandı. Hastalar ortalama 35±20 ay (dağılım 12-75 ay) takip edildi.
Sonuçlar: Tüm hastalarda ortalama 4.5 ayda kaynama elde edildi. Son kontrollerde ortalama TAEHA değeri 200±39.5° (dağılım 160°-260°) hesaplandı. Bu açıdan, altı parmakta (%33.3) mükemmel, beş parmakta (%27.8) iyi, yedi parmakta (%38.9) orta sonuç alındı. Mini vidalar ile tespit sağlanan 11 kırığın sekizinde (%72.7), mini plak ve vidalar ile tespit sağlanan yedi kırığın üçünde (%42.9) mükemmel veya iyi TAEHA elde edildi. Ameliyat edilen elde kavrama gücünde sağlam tarafa göre ortalama %7.5 (dağılım %0-%20) azalma görüldü. Q-DASH skoru ortalama 3.4±4.4 bulundu. Page ve Stern sınıflamasına göre, yedi önemli (%38.9), altı hafif (%33.3) komplikasyon görüldü. İki parmakta (%11.1) kaynama gecikmesi gözlendi.
Çıkarımlar: Cerrahi müdahale gerektiren falanks kırıklarında açık redüksiyon ve plak ya da vida tespiti ilk seçenek değildir. Eğer açık düzeltme ve internal tespit yapılması gerekliyse, mümkün olan en minimal invaziv yöntem (vida tespiti gibi) kullanılmalıdır.

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Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Ufuk Nalbantoglu This is me

Arel Gereli This is me

Feridun Cilli This is me

Bekir Ucar This is me

Metin Turkmen This is me

Publication Date September 22, 2009
Published in Issue Year 2009 Volume: 43 Issue: 4

Cite

APA Nalbantoglu, U., Gereli, A., Cilli, F., Ucar, B., et al. (2009). Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Acta Orthopaedica Et Traumatologica Turcica, 43(4), 317-323.
AMA Nalbantoglu U, Gereli A, Cilli F, Ucar B, Turkmen M. Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Acta Orthopaedica et Traumatologica Turcica. September 2009;43(4):317-323.
Chicago Nalbantoglu, Ufuk, Arel Gereli, Feridun Cilli, Bekir Ucar, and Metin Turkmen. “Open Reduction and Low-Profile Plate and/Or Screw Fixation in the Treatment of Phalangeal Fractures”. Acta Orthopaedica Et Traumatologica Turcica 43, no. 4 (September 2009): 317-23.
EndNote Nalbantoglu U, Gereli A, Cilli F, Ucar B, Turkmen M (September 1, 2009) Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Acta Orthopaedica et Traumatologica Turcica 43 4 317–323.
IEEE U. Nalbantoglu, A. Gereli, F. Cilli, B. Ucar, and M. Turkmen, “Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures”, Acta Orthopaedica et Traumatologica Turcica, vol. 43, no. 4, pp. 317–323, 2009.
ISNAD Nalbantoglu, Ufuk et al. “Open Reduction and Low-Profile Plate and/Or Screw Fixation in the Treatment of Phalangeal Fractures”. Acta Orthopaedica et Traumatologica Turcica 43/4 (September 2009), 317-323.
JAMA Nalbantoglu U, Gereli A, Cilli F, Ucar B, Turkmen M. Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Acta Orthopaedica et Traumatologica Turcica. 2009;43:317–323.
MLA Nalbantoglu, Ufuk et al. “Open Reduction and Low-Profile Plate and/Or Screw Fixation in the Treatment of Phalangeal Fractures”. Acta Orthopaedica Et Traumatologica Turcica, vol. 43, no. 4, 2009, pp. 317-23.
Vancouver Nalbantoglu U, Gereli A, Cilli F, Ucar B, Turkmen M. Open reduction and low-profile plate and/or screw fixation in the treatment of phalangeal fractures. Acta Orthopaedica et Traumatologica Turcica. 2009;43(4):317-23.