Outcomes of osteotomy and rigid internal fixation treatment for the correction of phalangeal malunions
Abstract
Abstract Objective: To present the results and complications of a series of phalangeal malunion patients. Materials and Methods: A retrospective study was conducted on phalangeal malunion patients treated with an osteotomy at the deformity site and stabilized with rigid internal fixation. Postoperative mobility of the digit was recorded. The subjective assessment used the Disabilities of the Arm, Shoulder and Hand (DASH) score and a Visual Analogue Scale (VAS) to rate their function and pain at rest and during activity. Results: Twelve patients (13 phalanges) met the inclusion criteria. The average time between fracture and osteotomy was 14 months and the mean follow-up was 34 months. Final mobility in flexo-extension was: 89 degrees for metacarpophalangeal joint, 74 degrees proximal interphalangeal joint, 54 degrees distal interphalangeal joint. The average VAS pain score was 0 at rest and 1 during activity, and the average function was 7 points. The average DASH score was 6. There were no cases of nonunion. Five patients required plate removal. No patients with articular osteotomy presented signs of Osteoarthritis. Conclusions: Phalangeal osteotomy at the deformity site is an effective procedure with good objective and subjective short-term outcomes. Patients should be warned about the possibility of a second procedure in cases of plate fixation due to a higher complication rate associated with plate and screw fixations.Downloads
References
Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand. Hand Clin 2000;16(3):323-32, vii. PMID: 10955206
Büchler U, Gupta A, Ruf S. Corrective osteotomy for post-traumatic malunion of the phalanges in the hand. J Hand Surg Br 1996;21(1):33-42. https://doi.org/10.1016/s0266-7681(96)80009-x
Manktelow RT, Mahoney JL. Step osteotomy: a precise rotation osteotomy to correct scissoring deformities of the fingers. Plast Reconstr Surg 1981;68(4):571-6. PMID: 7280104
Gross MS, Gelberman RH. Metacarpal rotational osteotomy. J Hand Surg Am 1985;10(1):105-8. https://doi.org/10.1016/s0363-5023(85)80259-8
Trumble T, Gilbert M. In situ osteotomy for extra-articular malunion of the proximal phalanx. J Hand Surg Am 1998;23(5):821-6. https://doi.org/10.1016/S0363-5023(98)80156-1
Potenza V, De Luna V, Maglione P, Garro L, Farsetti P, Caterini R. Post-traumatic malunion of the proximal phalanx of the finger. Medium-term results in 24 cases treated by “in situ” osteotomy. Open Orthop J 2012. https://doi.org/10.2174/1874325001206010468
Botelheiro JC. Overlapping of fingers due to malunion of a phalanx corrected by a metacarpal rotational osteotomy--report of two cases. J Hand Surg Br 1985;10(3):389-90. https://doi.org/10.1016/s0266-7681(85)80070-x
Menon J. Correction of rotary malunion of the fingers by metacarpal rotational osteotomy. Orthopedics 1990;13(2):197-200. PMID: 2308879
Pieron AP. Correction of rotational malunion of a phalanx by metacarpal osteotomy. J Bone Joint Surg Br 1972;54(3):516-9. https://doi.org/10.1302/0301-620X.54B3.516
Gollamudi S, Jones WA. Corrective osteotomy of malunited fractures of phalanges and metacarpals. J Hand Surg Br 2000;25(5):439-41. https://doi.org/10.1054/jhsb.2000.0418
Pichora DR, Meyer R, Masear VR. Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion. J Hand Surg Am 1991;16(3):551-5. https://doi.org/10.1016/0363-5023(91)90031-6
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg 2004;240(2):205-13. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol. 2009;34(1):137-8. https://doi.org/10.1177/17531934097321
van der Lei B, de Jonge J, Robinson PH, Klasen HJ. Correction osteotomies of phalanges and metacarpals for rotational and angular malunion: a long-term follow-up and a review of the literature. J Trauma 1993;35(6):902-8. https://doi.org/10.1097/00005373-199312000-00017
Balaram AK, Bednar MS. Complications after the fractures of metacarpal and phalanges. Hand Clin 2010;26(2):169-77. https://doi.org/10.1016/j.hcl.2010.01.005
Gajendran VK, Gajendran VK, Malone KJ. Management of complications with hand fractures. Hand Clin 2015;31(2):165-77. https://doi.org/10.1016/j.hcl.2014.12.001
Ataker Y, Uludag S, Ece SC, Gudemez E. Early active motion after rigid internal fixation of unstable extra-articular fractures of the proximal phalanx. Hand Surg Eur Vol 2017;42(8):803-9. https://doi.org/10.1177/1753193417709949
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
