Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

Soohyun Lee; Soonchul Lee; Jun-Ku Lee; Youngsuk Sim; Dae-Sung Choi; Soo-Hong Han

doi:10.12790/jkssh.2017.22.3.189

Journal List > J Korean Soc Surg Hand > v.22(3) > 1106570

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Lee, Lee, Lee, Sim, Choi, and Han: Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

Original Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(3): 189-195.

Published online: 26 September 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.3.189

Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

Soohyun Lee¹, Soonchul Lee¹, Jun-Ku Lee², Youngsuk Sim¹, Dae-Sung Choi¹, Soo-Hong Han¹

¹Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

²Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea.

Correspondence to: Soo-Hong Han. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. TEL: +82-31-780-5289, FAX: +82-31-708-3578, hsoohong@hanmail.net

Received 6 June 2017 Revised 3 July 2017 Accepted 21 July 2017

The Korean Society for Surgery of the Hand

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results.

Methods

This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated.

Results

Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up.

Conclusion

Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.

Keywords: Fractures, Metacarpal bones, Finger phalanges, Open fracture reduction

Figures and Tables

Fig. 1

Rotational angle measurement of right 4th middle phalanx fractured hand.

Fig. 2

Radiologic measurement methods of anteropaterior angulation (A), saggital angulation (B), and fracture bone height (C).

Fig. 3

A 38-year-old woman was injured from traction injury resulting in minimally displaced spiral fracture on left 4th finger proximal phalanx. Initial anteroposterior and oblique plan radiographs (A, B). Physical examination in outpatient clinic presented 4th finger overlapping on 4th finger (C). Intraoperative clinical photo of open reduction and internal fixation (D). Correction of rotational alignment after operation (D). Postoperative AP plain radiographs (E) showed anatomic reduction and proper fixation with two lag screws.

Fig. 4

Repeated measures analysis of variance result. Serial measurement represented preoperative and postoperative passive angle measurement under anesthesia and final follow up active angle measurement between convergent and divergent group.

Fig. 5

Paired T-test between immediate postoperative fractured hand angle and unaffected healthy control angle.

Table 1

Descriptive values

Values are presented as number (%).

Table 2

Fractured finger and bone

Table 3

Radiologic parameter

Values are presented as mean (±standard deviation).

AP, anteroposterior.

Notes

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C1398) and Bio & Medical Technology Development Program of the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (No. 2016M3A9E8941670, 2016R1D1A1B03932856).

^{CONFLICT OF INTEREST} No potential conflict of interest relevant to this article was reported.

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