Operative treatment of the phalangeal neck fracture in hand

Abstract

It is generaly accepted that displaced phalangeal neck fractures in hands accelerate the onset of degenerative changes, with increasing pain and stiffness of the affected joint. However, reports on the results of surgical treatment in phalangeal neck fractures are relatively few. We have followed sixteen patients, who had operations for phalangeal neck fractures. The average length of follow up was 13 months. The interval between injury and operation ranged from three days to six years, whith a mean of 18 months. The second finger was the most frcquently injured. The phalangeal neck had been displaced with rotation in 9 cases and slightly displaced without rotation in 7 cases. The most common surgical approach was a mid-dorsal incision. Of 16 cases, thirteen required open reduction and internal fixation with a K-wire, either for dorsal displacement and volar angulation of the head or for a 180 degree proximal rotation of the head. The pull-out wire technique was the second most common fixation method. Excellent and good results were noted in 10 cases(62%). Complications were found in seven cases and loss of motion was the most frequent. Late malrotation with angulation occurred in one case.