American Association for Hand Surgery
Theme: Beyond Innovation

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Complications of Low-Profile Plate Fixation of Phalanx Fractures
Evan M Guerrero, MD1; Rita E Baumgartner, MD1; Andrew E Federer, MD1; Suhail K. Mithani, MD2; David S. Ruch, MD3; Marc J. Richard, MD4
1Duke University Health System, Durham, NC, 2Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, 3Duke University, Durham, NC, 4Duke University Medical Center, Durham, NC

Introduction
Phalanx fractures are the second most common upper extremity fracture. Many phalanx fractures can be successfully treated non-operatively, but if it is not possible to immobilize the fracture in acceptable alignment, open reduction and internal fixation (ORIF) may be required. There is ongoing discussion regarding optimal treatment for different fracture patterns. Due to the theoretical advantage of precise alignment and stable fixation, plate fixation is often used to treat unstable or comminuted fractures. However, major complications have been reported in up to 52% of phalanx fractures treated with plate fixation, with stiffness being most common. Low profile anatomic plates (LPAP) have been designed to require less soft tissue dissection, thereby decreasing both soft tissue irritation and postoperative stiffness. The objective of this study was to determine if use of LPAP has decreased complications in plate fixation of phalangeal fractures as compared to historical data of earlier generation plates.
Materials & Methods
A retrospective chart review was performed of patients with phalanx fractures treated with ORIF using LPAP at a single institution from 1/1/2010 to 1/25/2018. Patients with concomitant tendon injury, same digit phalanx fracture, revision surgery, surgery for malunion, and follow up < 1 month were excluded. Twenty-three patients with 23 phalanx fractures treated with LPAP were included. The primary outcome was presence of a complication.
Results
Of the 23 fractures, 18 (78.3%) fractures were comminuted and 18 (78.3%) were intra-articular. Twelve (52.2%) patients had a postoperative complication. Nine (39.1%) patients required return to the operating room, with 7 (30.4%) returning for removal of hardware and tenolysis/capsulotomy to improve range of motion. Two (8.70%) patients had superficial infections, with one requiring irrigation and debridement. The other infection resolved after two courses of oral antibiotics, with the fracture going on to nonunion. There was one patient with delayed wound healing treated prophylactically with Cephalexin; although her wound healed, she developed a boutonniere deformity requiring surgery. There were two (8.70%) malunions,one requiring revision to hemi-hamate arthroplasty, and the other electing for nonoperative management. All but one fracture progressed to union; no patients required narcotic pain medication at final follow up.
Conclusions
ORIF with LPAP consistently achieves fracture union and pain relief for phalanx fractures; however, it does not appear that LPAP reduce the high complication rate, and patients should be counseled appropriately.


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