Outcomes of osteotomy and rigid internal fixation treatment for the correction of phalangeal malunions
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Published:
May 2, 2020
Keywords:
osteotomy, phalanx, malunion
Main Article Content
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.
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.
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How to Cite
Rellán, I., Ferreira, L., De Carli, P., Gallucci, G. L., Donndorff, A., Zaidenberg, E. E., & Boretto, J. G. (2020). Outcomes of osteotomy and rigid internal fixation treatment for the correction of phalangeal malunions. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(2), 125-132. https://doi.org/10.15417/issn.1852-7434.2020.85.2.932
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Clinical Research
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References
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9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. Menon J. Correction of rotary malunion of the fingers by metacarpal rotational osteotomy. Orthopedics 1990;13(2):197-200. PMID: 2308879
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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