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Outcome of closed proximal phalangeal fractures of the hand

BACKGROUND: The proximal phalanx (PP) of the fingers is fractured more frequently than the middle or even distal phalanges. The problems of malunion, stiffness and sometimes loss of skin or other soft tissues associated with PP fracture increases the disability. The optimum treatment depends on frac...

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Autores principales: Singh, Jaswinder, Jain, Karun, Mruthyunjaya, Ravishankar, R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications Pvt Ltd 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162680/
https://www.ncbi.nlm.nih.gov/pubmed/21886925
http://dx.doi.org/10.4103/0019-5413.83764
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author Singh, Jaswinder
Jain, Karun
Mruthyunjaya,
Ravishankar, R
author_facet Singh, Jaswinder
Jain, Karun
Mruthyunjaya,
Ravishankar, R
author_sort Singh, Jaswinder
collection PubMed
description BACKGROUND: The proximal phalanx (PP) of the fingers is fractured more frequently than the middle or even distal phalanges. The problems of malunion, stiffness and sometimes loss of skin or other soft tissues associated with PP fracture increases the disability. The optimum treatment depends on fracture location, fracture geometry and fracture stability. The objective of the study was to analyse the treatment outcome in a series of closed proximal phalangeal fractures of the hand. MATERIALS AND METHODS: Eighty-four proximal phalangeal fractures in 68 patients were enrolled from 2007 to 2009. The treatment modalities were broadly categorised into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment. Group A included 47 digits treated with closed reduction (CR) with immobilization (n=43), extension block cast and dynamic traction (n=4), while 37 digits were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=31), OR and IF with stainless-steel wiring (n=2), and mini external-fixator (n=4). Belsky's criteria and Gingrass’ criteria were used for assessment of finger injuries and to assess the efficacy of conservative and surgical modalities for closed proximal phalangeal fractures of the hand. RESULTS: Average period of follow-up was 1 year (range 10-14 months). The excellent to good results seen in Groups A and B were 89% and 92%, respectively. Six complications were seen in Group A, which included four cases with malunion and two cases with digital stiffness. Three complications were seen in Group B, which included one each of malunion, digital stiffness and extensor lag. Overall, maximum poor results (n=4) were seen with CR and buddy strapping. CONCLUSION: Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery, Surgical modalities have distinct advantage of stable fixation, but with added risk of digital stiffness. Percutaneous pinning is a reliable, most commonly used surgical modality and technically easier. Both conservative and surgical modalities have good efficacy when used judiciously
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spelling pubmed-31626802011-09-01 Outcome of closed proximal phalangeal fractures of the hand Singh, Jaswinder Jain, Karun Mruthyunjaya, Ravishankar, R Indian J Orthop Original Article BACKGROUND: The proximal phalanx (PP) of the fingers is fractured more frequently than the middle or even distal phalanges. The problems of malunion, stiffness and sometimes loss of skin or other soft tissues associated with PP fracture increases the disability. The optimum treatment depends on fracture location, fracture geometry and fracture stability. The objective of the study was to analyse the treatment outcome in a series of closed proximal phalangeal fractures of the hand. MATERIALS AND METHODS: Eighty-four proximal phalangeal fractures in 68 patients were enrolled from 2007 to 2009. The treatment modalities were broadly categorised into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment. Group A included 47 digits treated with closed reduction (CR) with immobilization (n=43), extension block cast and dynamic traction (n=4), while 37 digits were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=31), OR and IF with stainless-steel wiring (n=2), and mini external-fixator (n=4). Belsky's criteria and Gingrass’ criteria were used for assessment of finger injuries and to assess the efficacy of conservative and surgical modalities for closed proximal phalangeal fractures of the hand. RESULTS: Average period of follow-up was 1 year (range 10-14 months). The excellent to good results seen in Groups A and B were 89% and 92%, respectively. Six complications were seen in Group A, which included four cases with malunion and two cases with digital stiffness. Three complications were seen in Group B, which included one each of malunion, digital stiffness and extensor lag. Overall, maximum poor results (n=4) were seen with CR and buddy strapping. CONCLUSION: Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery, Surgical modalities have distinct advantage of stable fixation, but with added risk of digital stiffness. Percutaneous pinning is a reliable, most commonly used surgical modality and technically easier. Both conservative and surgical modalities have good efficacy when used judiciously Medknow Publications Pvt Ltd 2011 /pmc/articles/PMC3162680/ /pubmed/21886925 http://dx.doi.org/10.4103/0019-5413.83764 Text en © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Singh, Jaswinder
Jain, Karun
Mruthyunjaya,
Ravishankar, R
Outcome of closed proximal phalangeal fractures of the hand
title Outcome of closed proximal phalangeal fractures of the hand
title_full Outcome of closed proximal phalangeal fractures of the hand
title_fullStr Outcome of closed proximal phalangeal fractures of the hand
title_full_unstemmed Outcome of closed proximal phalangeal fractures of the hand
title_short Outcome of closed proximal phalangeal fractures of the hand
title_sort outcome of closed proximal phalangeal fractures of the hand
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162680/
https://www.ncbi.nlm.nih.gov/pubmed/21886925
http://dx.doi.org/10.4103/0019-5413.83764
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