Background:
Unstable phalangeal fractures constitute a challenge for
surgeons with many options for operative treatment. Miniplate
fixation of these fractures has the advantages of stability and
neutralization of bending, rotational, and shear forces. To our
knowledge, this is the first study to compare the functional
results of an extensor tendon splitting approach with an
extensor tendon sparing approach in extraarticular proximal
phalangeal fracture fixed with a miniplate and screws.
Methods:
In a randomized prospective study we compared two groups of
patients: group A, patients treated with an extensor tendon
splitting approach (24 fractures in 21 patients with average age
31.9 yr) and group B, patients treated with an extensor tendon
sparing approach (26 fractures in 19 patients with average age
30.8 yr). The final results were assessed with total active range of
motion (TAM), grade of TAM, grip strength and Quick Disability
of the Arm, Shoulder, and Hand (DASH) Score.
Results:
A TAM of 220 degrees or more was achieved in 79.2% (19/24) and
84.6% (22/26) of fractures in group A and B, respectively. There
was a significant reduction in grip strength in group A compared to
group B (45.9 ± 8.4 kg vs. 51.7 ± 7.3 kg; P< 0.025). Other parameters
showed slightly better results in group B compared with
group A but the differences were statistically insignificant in regard
to time to union (5.3þ 1 wk vs. 5.6þ 1.1 wk), TAM (226.8þ 18.4
degrees vs. 233.2þ 17.5 degrees), grading of TAM (excellent score
75% vs. 80.8%) and QuickDASH score (12 ± 9.2 vs. 11.5 ± 8.3).
Conclusions:
Meticulous surgical dissection, anatomical closure of layers, and
early active mobilization are the keys to success in fixation of
phalangeal fractures regardless the approach chosen.