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Outcomes of Periarticular Pinning in Proximal Phalanx Fractures
Anna Babushkina, MD; Juliana Rojas Neira, MD; Chaitanya Mudgal, MD
Massachusetts General Hospital, Boston, MA

Introduction: Proximal phalangeal fractures account for the majority of hand fractures and can result in a great deal of morbidity in motion deficit. Periarticular pinning has been shown to be a good treatment option in fractures at the base of the proximal phalanx. The goal of this study was to review results of periarticular pinning of the proximal phalanx in fractures at the base as well as the shaft.
Methods: A retrospective review of the senior author's records over 6 years yielded 50 surgical treatments of proximal phalangeal fractures in 43 patients. All underwent periarticular pinning of their unstable fractures. Records were reviewed to ascertain time to healing, fracture demographics, functional results and complication rates.
Results: A total of 19 males and 24 females underwent percutaneous periarticular pinning between 2006 and 2012 under the care of the senior author. A total of 50 fingers were treated. This included 16 shaft and 34 basal fractures. Five fractures were open (10%). The small finger was involved in 62%, the ring in 30%, index and middle in 4% each. Most fractures were either transverse or oblique and just over half had comminution and/or impaction. Three patients developed PIP stiffness requiring tenolysis, one patient had a pin site infection that was treated with antibiotics, and another had a pin site infection with some loss of reduction. Average follow up was 105 days. Average time to union defined as clinically nontender fracture site and radiographic bony bridging from date of surgery was 34.7 days. Twenty six fingers (52%) achieved excellent results, lacking 10 degrees or less of motion. Seven patients (14%) had good results, lacking less than 20 degrees of motion in either direction. Another seven had fair results, lacking 40 to 60 degrees of motion. And one had poor results lacking greater than 60 degrees of motion. Two of the patients who underwent tenolysis as a secondary procedure achieved excellent motion as an end result, lacking only 10 degrees of full extension. Results for shaft fractures were not significantly different from those for base fractures.
Conclusions: Percutaneous periarticular pinning is a good surgical option for unstable metaphyseal and diaphyseal fractures of the proximal phalanx. Loss of PIP motion can be expected in 15 to 30 percent of patients.


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