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Outcomes of reduction and plate fixation in hand phalanx fractures

Yıl 2019, Cilt: 44 Sayı: Ek 1, 427 - 433, 29.12.2019
https://doi.org/10.17826/cumj.560382

Öz

Purpose: The aim of this study is to evaluate the radiological and functional results of open reduction, mini plate fixation in multifragmanter, shortness and followed by loss of reduction in the fractures of the phalanx,

Materials and Methods: Between 2008 and 2016, patients who underwent mini plate and screw fixation due to 28 phalangeal fractures in our hospital were evaluated retrospectively. 30 phalanges of 28 patients were included in the study. Quick Dash scores, Grip strength, Functional range of motion were examined. The duration of union, duration of stay, duration of surgery and complications were evaluated.

Results: The mean age of the patients was 37.3 (23-57) and the mean follow-up period was 23 (7-84) months. Quick Dash scores in the final follow-up of the patients were evaluated as 8.43 (0-27.5). The grip strength was 43 (25-60) kgW in the fracture and 47 (35-60) kgW in healthy. The total range of motion of the 3 joints of the patients (MP, PIP, DIP) was 240 ° (170 -270). The mean union time of the patients was 34.9 days (25-50). The mean duration of hospital stay was 1.45 days (1-3). The mean duration of surgery was 60.25 min (45-90). Functionally, 6 of 28 patients had joint stiffness and 1 rotation. Six patients were not satisfied with the surgery.18 patients complained of swelling of the fingers. 

Conclusion: The advantage of open reduction and plate fixation in phalangeal fractures is a rigid fixation and decreased labor loss in the early period. In the early postoperative period, starting hand movement is important for patients with limited mobility. Surgical treatment of multifragmanter, displacement and shortness phalangeal fractures provides an advantage in early period; Rotation and joint stiffness are the major problems that may be encountered after surgery.


Kaynakça

  • 1. Çolak M , Eskandari M. Fractures of the distal phalanx TOTBİD Dergisi 2014; 12:108–118
  • 2. Honeycutt PB, Jernigan EW, Rummings WA Jr, Stern PJ, Draeger RW Volar Anatomy of the Proximal Phalanx: Implications for Screw Length Selection for Fixation of Shaft Fractures J Hand Surg Am. 2017;42(3):e149-e157
  • 3. Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, et al., editors. Green’s Operative Hand Surgery. 5th ed. Vol 1, Philadelphia: Elsevier; 2005. p.277–341
  • 4. Nalbantoğlu U , Gereli A Proximal and middle phalangeal fractures TOTBİD Dergisi 2014; 12:119–124
  • 5. Aykut S, Öztürk K, Özcan Ç. Results of surgical treatment in metacarpal shaft fractures using low profile mini plates. Ulus Travma Acil Cerrahi Derg. 2015;21(4):279-84
  • 6. Milner C, Samson D, Tan S. Unstable Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joint: Volar Plate Fixation with or without Bone Graft. J Hand Surg Asian Pac Vol. 2019;24(1):50-54
  • 7. Lögters TT, Lee HH, Gehrmann S, Windolf J, Kaufmann RA Proximal Phalanx Fracture Management Hand (N Y). 2018;13(4):376-383
  • 8. Morgan WJ, Slowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg 2001;9(6):389–400
  • 9. Stern PJ. Fractures of the metacarpals and phalangeas. In: Green DP, Hotchkiss RN, Pederson WC, eds. Operative hand surgery. 4th ed. New York: Churchill Livingstone, 1999:716.
  • 10. Azboy İ , Alemdar C , Demirtaş A Effects of postoperative early motion on the results of osteosynthesis with miniplates in metacarpal fractures JCEI 2013; 4 (4): 457-462
  • 11. Doruk P, Leblebici B, Adam M. Compartment syndrome developed due to the plaster cast :Three cases report Cukurova Med J. 2013; 38(4): 774-778
  • 12. Minhas SV, Catalano LW 3rd Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention J Hand Surg Am. 2019 Jan;44(1):65.e1-65.e713. Freeland AE, Orbay JL Extraarticular hand fractures in adults: a review of new developments Clin Orthop Relat Res. 2006;445:133-45
  • 14. Henry M. Soft tissue sleeve approach to open reduction and internal fixation of proximal phalangeal fractures. Tech Hand Up Extrem Surg. 2008;12(3):161-5
  • 15. Rettig AC Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand Am J Sports Med. 2004 Jan-Feb;32(1):262-73
  • 16. Gajendran VK, MD , Malone KJ, MD Management of Complications with Hand Fractures Hand Clin 31 (2015) 165–177
  • 17. von Kieseritzky J, Nordström J, Arner M. Reoperations and postoperative complications after osteosynthesis of phalangeal fractures: a retrospective cohort study J Plast Surg Hand Surg. 2017;51(6):458-462
  • 18. Jovanovic N, Aldlyami E, Saraj B Intramedullary Percutaneous Fixation of Extra-Articular Proximal and Middle Phalanx Fractures. Tech Hand Up Extrem Surg. 2018 ;22(2):51-56
  • 19. Köse A, Topal M, Engin MÇ, Şencan A, Dinçer R, Baran T Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures Eur J Orthop Surg Traumatol. 2019;29(3):597-604
  • 20. Robinson LP, Gaspar MP, Strohl AB Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study Arch Orthop Trauma Surg. 2017;137(4):567-572
  • 21. Xu J, Zhang C Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis Zhang J Orthop Surg Res. 2015;26:10:43.
  • 22. Kurzen, P, Cesare Fusetti,C , Mario Bonaccio, M , Nagy L, Complications after Plate Fixation of Phalangeal Fractures J Trauma. 2006; 60:841– 843.
  • 23. Pun WK, Chow SP, So YC et all Unstable phalangeal fractures: treatment by A.O. screw and plate fixation J Hand Surg Am. 1991;16(1):113-7
  • 24. Desaldeleer-Le Sant AS, Le Sant A, Beauthier-Landauer V, Kerfant N, Le Nen D Surgical management of closed, isolated proximal phalanx fractures inthe longfingers: Functi-onal outcomes and complications of 87 fractures. Hand Surg Rehabil. 2017;36(2):127-135

El falanks kırıklarında açık redüksiyon ve plak ile fiksasyonun sonuçları

Yıl 2019, Cilt: 44 Sayı: Ek 1, 427 - 433, 29.12.2019
https://doi.org/10.17826/cumj.560382

Öz

Amaç: Multifragmanter, kısalık oluşan ve takiplerinde redüksiyon kaybı görülen falanks kırıklarının açık redüksiyon, mini plak ile fiksasyonunun radyolojik ve fonksiyonel sonuçlarını degerlendirmektir.

Gereç ve Yöntem: 2008–2016 Yılları arasında hastanemizde 28 tane falanks kırığı sebebiyle mini plak ile fiksasyon yapılan hastalar retrospektif olarak incelenmiştir. 28 hastanın 30 falanksı çalışmaya dahil edilmiştir. Hastalar son kontrollerine geldiğinde Quick Dash skorları, kavrama kuvvetlerine, fonksiyonel eklem hareket açıklığına bakılmıştır. Hastaların kaynama süresi, yatış süresileri, cerrahi süre ve komplikasyonlar değerlendirilmiştir.

Bulgular: Hastaların ortalama yaşları 37.3(23–57) ortalama takip süresi 23 (7–84) aydır. Hastaların son kontrollerindeki Quick Dash skorları ortalama 8,43(0-27,5) olarak değerlendirilmiştir. Kavrama kuvveti kırık elde 43 (25-60) kgW, sağlıklı elde 47 (35-60) kgW olarak ölçüldü. Hastaların 3 ekleminin (MP, PİP, DİP) toplam hareket açıklığı 240°(170 –270) olarak ölçülmüştür. Hastaların ortalama kaynama süresi 34.9 gün (25-50) dür. Hastaların yatış süresi ortalama 1.45 Gün (1-3) dür. Cerrahi süresi ortalama 60.25 dk (45-90) dır. Klinik olarak 28 hastanın 6 tanesinde eklem sertliği 1 tanesinde rotasyon tespit edilmiştir. 6 hasta yapılan cerrahiden memnun olmadığı görülmüştür.18 hasta parmaklarında şişlik kalmasından şikayetçiydi. 

Sonuç: Falanks kırıklarında açık redüksiyon ve internal fiksasyon yapmanın avantajı rigit bir tespit erken dönemde iş gücü kaybının azalmasıdır. Hastalara cerrahi sonrası erken dönemde hareket başlanması hareket kısıtlılığı açısından önemlidir. Multifragmanter, deplase ve kısalık oluşan falanks kırıklarında cerrahi erken dönemde hareket verme avantajı sağlar. Rotasyon ve eklem sertliği cerrahi sonrası karşılaşabilecek sorunların başında gelmektedir.


Kaynakça

  • 1. Çolak M , Eskandari M. Fractures of the distal phalanx TOTBİD Dergisi 2014; 12:108–118
  • 2. Honeycutt PB, Jernigan EW, Rummings WA Jr, Stern PJ, Draeger RW Volar Anatomy of the Proximal Phalanx: Implications for Screw Length Selection for Fixation of Shaft Fractures J Hand Surg Am. 2017;42(3):e149-e157
  • 3. Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, et al., editors. Green’s Operative Hand Surgery. 5th ed. Vol 1, Philadelphia: Elsevier; 2005. p.277–341
  • 4. Nalbantoğlu U , Gereli A Proximal and middle phalangeal fractures TOTBİD Dergisi 2014; 12:119–124
  • 5. Aykut S, Öztürk K, Özcan Ç. Results of surgical treatment in metacarpal shaft fractures using low profile mini plates. Ulus Travma Acil Cerrahi Derg. 2015;21(4):279-84
  • 6. Milner C, Samson D, Tan S. Unstable Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joint: Volar Plate Fixation with or without Bone Graft. J Hand Surg Asian Pac Vol. 2019;24(1):50-54
  • 7. Lögters TT, Lee HH, Gehrmann S, Windolf J, Kaufmann RA Proximal Phalanx Fracture Management Hand (N Y). 2018;13(4):376-383
  • 8. Morgan WJ, Slowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg 2001;9(6):389–400
  • 9. Stern PJ. Fractures of the metacarpals and phalangeas. In: Green DP, Hotchkiss RN, Pederson WC, eds. Operative hand surgery. 4th ed. New York: Churchill Livingstone, 1999:716.
  • 10. Azboy İ , Alemdar C , Demirtaş A Effects of postoperative early motion on the results of osteosynthesis with miniplates in metacarpal fractures JCEI 2013; 4 (4): 457-462
  • 11. Doruk P, Leblebici B, Adam M. Compartment syndrome developed due to the plaster cast :Three cases report Cukurova Med J. 2013; 38(4): 774-778
  • 12. Minhas SV, Catalano LW 3rd Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention J Hand Surg Am. 2019 Jan;44(1):65.e1-65.e713. Freeland AE, Orbay JL Extraarticular hand fractures in adults: a review of new developments Clin Orthop Relat Res. 2006;445:133-45
  • 14. Henry M. Soft tissue sleeve approach to open reduction and internal fixation of proximal phalangeal fractures. Tech Hand Up Extrem Surg. 2008;12(3):161-5
  • 15. Rettig AC Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand Am J Sports Med. 2004 Jan-Feb;32(1):262-73
  • 16. Gajendran VK, MD , Malone KJ, MD Management of Complications with Hand Fractures Hand Clin 31 (2015) 165–177
  • 17. von Kieseritzky J, Nordström J, Arner M. Reoperations and postoperative complications after osteosynthesis of phalangeal fractures: a retrospective cohort study J Plast Surg Hand Surg. 2017;51(6):458-462
  • 18. Jovanovic N, Aldlyami E, Saraj B Intramedullary Percutaneous Fixation of Extra-Articular Proximal and Middle Phalanx Fractures. Tech Hand Up Extrem Surg. 2018 ;22(2):51-56
  • 19. Köse A, Topal M, Engin MÇ, Şencan A, Dinçer R, Baran T Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures Eur J Orthop Surg Traumatol. 2019;29(3):597-604
  • 20. Robinson LP, Gaspar MP, Strohl AB Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study Arch Orthop Trauma Surg. 2017;137(4):567-572
  • 21. Xu J, Zhang C Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis Zhang J Orthop Surg Res. 2015;26:10:43.
  • 22. Kurzen, P, Cesare Fusetti,C , Mario Bonaccio, M , Nagy L, Complications after Plate Fixation of Phalangeal Fractures J Trauma. 2006; 60:841– 843.
  • 23. Pun WK, Chow SP, So YC et all Unstable phalangeal fractures: treatment by A.O. screw and plate fixation J Hand Surg Am. 1991;16(1):113-7
  • 24. Desaldeleer-Le Sant AS, Le Sant A, Beauthier-Landauer V, Kerfant N, Le Nen D Surgical management of closed, isolated proximal phalanx fractures inthe longfingers: Functi-onal outcomes and complications of 87 fractures. Hand Surg Rehabil. 2017;36(2):127-135
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Ortopedi
Bölüm Araştırma
Yazarlar

Çağrı Özcan 0000-0002-6651-3322

Yayımlanma Tarihi 29 Aralık 2019
Kabul Tarihi 7 Ağustos 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 44 Sayı: Ek 1

Kaynak Göster

MLA Özcan, Çağrı. “El Falanks kırıklarında açık redüksiyon Ve Plak Ile Fiksasyonun sonuçları”. Cukurova Medical Journal, c. 44, 2019, ss. 427-33, doi:10.17826/cumj.560382.