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Lateral versus Dorsal Plating for Metacarpal and Phalanx Fractures
Joshua W. Hustedt, MD, MHS1; Michael Bonnelli, BA1; Patricia Drace, MD2; Lloyd Champagne, MD3
1University of Arizona-Phoenix College of Medicine, Phoenix, AZ; 2Banner University Medical Center- Phoenix, Phoenix, AZ; 3Arizona Center for Hand Surgery, Phoenix, AZ

Introduction: Recent technological advances in locked plating for phalanx and metacarpal fractures has improved fixation options for these common injuries. However, there is debate on proper plate placement between the dorsal and lateral positions. Our study exams the rate of plate removal and clinical outcomes to determine the difference between lateral and dorsal locked plating in the hand.

Materials and Methods: We conducted a retrospective review of prospectively collected patients treated with locked plates by a single surgeon for hand fractures between the years 2009 to 2011. Rates of plate removal, percent total arc of motion (%TAM), and patient and injury demographics were compared based on plating position in univariate and multivariate models.

Results: 186 patients were treated with locked plates; 90 patients had metacarpal fractures and 88 had phalanx fractures. 110 patients had dorsal plates versus 76 lateral plates. Dorsal plating resulted in less total arc of motion after surgery (212 vs 226 degrees, p=0.04) For metacarpal fractures there was no significant difference in plate removal in dorsal versus lateral plating (p=0.746). However, in phalanx fractures dorsal plating resulted in significantly higher rates of plate removal (OR 6.6, 95% CI 1.34-31.9) than lateral plating. Larger T or Y type plates resulted in greater rates of plate removal than straight plates (p=0.005) in phalanx fractures.

Conclusions: These data suggest that dorsal and larger T or Y type plating results in increased rates of plate removal in phalanx but not metacarpal fractures. Additionally, lateral plating results in increased postoperative total arc of motion. Biomechanical studies have shown the equivalency in strength of lateral and dorsal plating. Therefore, lateral plating provides equivalent fracture fixation, increased clinical results, and decreased need for plate removal in phalanx fractures of the hand.

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