Ten-year results using a dynamic treatment for proximal phalangeal fractures of the hands.

Full article available online at Healio.com/Orthopedics. Search: 20130222-25 Fractures of the proximal phalanges of the hands can be treated by many methods. With surgical intervention, a loss in proximal interphalangeal joint movement is common. Using the stabilizing effect of the zancolli complex-metacarpophalangeal retention apparatus and an external device such as a thermoplastic metacarpophalangeal block splint, proximal phalangeal fractures can be stabilized in terms of axis, length, and rotation. This study reports the authors’ 10-year results managing these fractures with dynamic treatment. All patients with closed fractures of the proximal phalanges admitted to Queen Mary Hospital, Hong Kong, China, between July 2000 and June 2010 were analyzed. Fractures with rotational deformities or displaced intra-articular configurations were excluded. A dynamic splint that kept the metacarpophalangeal joint maximally flexed while allowing free movement of the proximal and distal interphalangeal joints of the injured finger was applied for at least 4 weeks. Results were evaluated using the Belsky classification and grip strength assessment. The results of 97 patients (103 fractures) were analyzed. At a minimum 1-year follow-up, 75% of patients attained excellent or good results. Neither nonunion nor delayed fracture union was noted. The 25% of patients who attained poor results were older than those who attained excellent or good results (average age, 53.1 vs 35.1 years, respectively) and tended to comply poorly with the rehabilitation program. Using the stabilizing effect of the zancolli complex-metacarpophalangeal retention apparatus and a metacarpophalangeal block splint, bone healing and movement recovery can be achieved simultaneously. The authors are from the Department of Orthopaedics and Traumatology (MWMF, BKKF, SPC), Queen Mary Hospital, The University of Hong Kong; the Department of Orthopaedics and Traumatology (WYI), The University of Hong Kong; and the Department of Occupational Therapy (RKYC), David Trench Rehabilitation Centre, Hong Kong, China. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Margaret Woon Man Fok, MBChB(Otago), FRCSEd(Orth), FHKCOS, FHKAM(Orthopaedic Surgery), Department of Orthopaedics and Traumatology, 5/F, Professorial Block, Queen Mary Hospital, The University of Hong Kong, Pokfulam Rd, Hong Kong, China (margaret_fok@yahoo.com). doi: 10.3928/01477447-20130222-25 Ten-year Results Using a Dynamic Treatment for Proximal Phalangeal Fractures of the Hands Margaret Woon Man Fok, FrCSeD(orth), FhkCoS; Wing Yuk ip, FrCS(e), MS(hk); BoriS kWok keung Fung, FrCSeD(ortho), FhCkoS; reBeCCa kitYuk Chan, MSC, pDot; SheW ping ChoW, FrCS(e), FaCS(uSa) Figure: Photograph of a metacarpophalangeal extension block splint allowing full flexion of the proximal and distal interphalangeal joints.