Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures

BACKGROUND: The purpose of this study was to determine the risk factors for postoperative finger stiffness after open reduction and internal fixation of unstable proximal phalangeal fractures using a low-profile plate and/or screw system. We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness. METHODS: Seventy consecutive patients (50 men, 20 women; average age, 40 years) with 75 unstable proximal phalangeal fractures were treated with titanium plates and/or screws and evaluated at a minimum follow-up of 1 year. Thirty-six comminuted fractures and 24 intra-articular fractures were included, and 16 fractures had associated soft-tissue injuries. Plate fixation was performed in 59 fractures, and the remaining 16 were fixed with screws only. The implants were placed in a dorsal location in 33 fractures and in a lateral or volar location in 42 fractures. Finger stiffness was defined as a total active range of finger motion <80% for the treated finger. Univariate and multivariate analyses were performed on 8 variables: patient characteristics (age and sex), fracture characteristics (fracture comminution, joint involvement, and associated soft-tissue injury), and surgical characteristics (type and location of implants and removal of the implants). RESULTS: Postoperative finger stiffness occurred in 38 fractures. The multivariate analysis indicated that plate fixation (odds ratio, 5.9; 95% confidence interval, 1.5–24.0; P = 0.01) and dorsal placement (odds ratio, 3.0; 95% confidence interval, 1.1–8.3; P = 0.03) were independent risk factors for finger stiffness. CONCLUSION: We recommend the use of screw fixation as much as possible for unstable proximal phalangeal fractures using a midlateral approach.