Specific Aims and Objectives:
Early studies on fixation of closed fractures in the hand using screws (S) and/or plates (P) showed excellent outcomes (Dabezies 1986, Bosch 1993, Pun 1991). However later studies which included compound fractures showed high levels of complications (Stern 1998). Studies included low numbers of phalangeal fractures, and combined these with metacarpal fractures, with a lack of differentiation between screws and plate fixation. The aim of this study is to investigate the outcomes of closed proximal phalangeal fractures fixed with currently available screws and/or plates. In addition, to investigate whether there is a difference in outcome between screw and plate fixation.
Methods:
Patients with closed proximal phalangeal fractures treated with screw or plate fixation were reviewed at least one year post operatively. The primary outcome was PIPJ arc of motion. Secondary outcomes were total active motion (TAM), grip strength, the Patient Evaluation Measure (PEM), Quick-DASH (Disabilities of Arm, Shoulder and Hand) Questionnaire and Patient Rated Wrist Hand Evaluation (PRWHE). Complications were recorded.
Results:
A total of 45 patients have been reviewed (S: 27, P: 18). The primary outcome of PIPJ arc of motion showed 93 and 81degrees in the screw and plate group respectively. TAM (operated vs non-operated side) was 94% and 89% respectively. Subjectively both groups reported similar levels of function and satisfaction (S:P) Q-DASH: 8:10, PRWHE 12:9 and PEM3 87:93. No infections were reported and the number of metalware removals was S: 2 and P: 1.
Discussion:
The outcomes in this group show an overall good range of motion with low complication rates. The preliminary outcomes of plate fixation are comparable to screw fixation. A sample size of 114 patients is required to provide sufficient power to determine a significant difference between screw and plate fixation and data collection is currently ongoing.