Functional Outcome and Complications of Open Reduction and Internal Fixation With Low-Profile Plates in Hand Fractures

Abstract

Introduction: Fractures of the metacarpals and phalanges are common injuries that account for up to 40% of upper extremity fractures. Such fractures occur in the age range between 10 and 40 years, are more common in men, and have a particular association with sports. Although conservative treatment is presented as an alternative therapy, the results are not always satisfactory. Plate fixation has demonstrated superior over other surgical methods in repeated biomechanical and clinical studies. There has been published literature that proves low-profile plates have even fewer complications than other surgical techniques that are less aggressive such as percutaneous pinning. The aim of this study is the retrospective evaluation of the clinical results and complications of patients with fractures of metacarpals and phalanges treated by open reduction internal fixation with low-profile plates. Materials and Methods: A retrospective review of the patient database for the period 2003-2014 was performed. Seventy-two patients who met the inclusion criteria were obtained. We identified 62 male and 14 female patients. The average age was 30.62 years (range, 15-58 years). An injury in the dominant hand was identified in 34 patients. For metacarpal fractures, a dorsal metacarpal approach over the affected bone was performed. A longitudinal incision is made on the periosteum, with the aim of preserving bone vascularity. The plate was placed dorsally. In the case of fractures of the proximal phalanx, a dorsolateral approach was performed. Bone was exposed through a longitudinal approach on the periosteum. The plate was placed dorsolateral in all cases. Additional compression screws were placed as needed according to the fracture type. The immediate postoperative period includes a wound coverage with padded bandages associated with immobilization antebrachiopalmar in intrinsic plus position. Passive motion and active immobilization were initiated at first and third week, respectively. Results: The final range of motion as rated by Duncan was grade I in 42 patients, grade II in 16 patients, grade III in 11 patients, and grade IV in 3 patients. The proportion of grip strength averaged 81.3% compared with the contralateral side. The time to fracture healing was 2.3 months. Complications were described: 4 cases of hypertrophic scar and keloid, 2 cases of complex regional pain syndrome, 6 cases of delayed union, 1 patient had a case of refracture. No cases of infection associated with osteosynthesis material were observed. We found that fractures in nondominant hand, intra-articular fractures, and delay in surgical treatment are associated with poorer functional outcomes ( P < .05). Conclusion: The low-profile plates are valid for the treatment for metacarpal and phalangeal fractures. Progress in implant design has reduced the complications attributed to the material. However, the range of mobility and functional end complications depend largely on the presence or absence of factors associated with the patient, the fracture, and the circumstances. In this study, we have shown that the presence of lesions in nondominant hand, the intra-articular commitment, and delayed surgical treatment are factors associated to low-end range of functional mobility.