Clinical And Radiological Outcomes Of Closed Reduction And Kirschner Wire Fixation In Treatment Of Extra-Articular Fractures Of The Proximal Phalanx

Abstract

Aim: In this study, we aim to discuss the radiological and clinical results of closed reduction and Kirschner wire fixation we performed on 16 cases with extra-articular unstable proximal phalangeal fracturesMaterials and Methods: Clinical and radiological data of 16 patients with closed, unstable (transverse or short oblique), extra-articular proximal phalangeal fractures to whom we performed closed reduction and fixation with Kirschner wire in Erzurum Regional Training and Research Hospital Orthopedics and Traumatology Clinic and Hand Surgery Clinic between 2014-2017 were retrospectively reviewedResults: Functional results of the patients are evaluated; mean active MP joint flexion was 78.75 (60-90) degrees, proximal IP joint flexion was 77.5 (65-100) degrees, distal IP joint flexion was 73.4 (60-80) degrees and mean TAM was 230 (170-270) degrees. Mean passive MP joint flexion was evaluated as 81.25 (60-90) degrees, mean proximal IP joint flexion as 83 (60-100) degrees and mean distal IP joint flexion as 74 (65-90) degrees. The grip strength was measured as 36 (23-50) kgW in the fractured hand and the healthy hand comparison was 40 (30-50) kgW. Statistically, there was no significant difference between the two groups in terms of grip strength (p<0.05). VAS mean was 1.25 (0-5), DASH mean was 10.5 (2-34), the mean distance between finger pulp and finger curve was 6.25 (0-23) mm. Belsky score was excellent in 4 patients, good in 9 patients and poor in 3 patients (Table 2). Two patients underwent tenolysis due to PIP joint contracture. Sudeck atrophy was observed in 1 patient for an average of 8 weeks. We achieved improvement with physical therapy, contrast bathing and medical treatment. There were no complications such as non-union, late union, superficial and deep infection, tenosynovitis. Our patients did not develop material extraction due to soft tissue and skin irritation. Radiologic evaluation of the follow up direct X-ray graphies revealed no displacement, angulation, and rotational deformities.Conclusion: The proximal phalanx is 'small in size' for the body and 'functioning big' for the upper limb. Fractures of the proximal phalanges can be fixed with Kirshner wires after failed stabilization with closed reduction and brace fixation. It is a practical method which has satisfactory outcomes and has a relatively low cost.