title: Results of osteotomy, open reduction, and internal fixation for late-presenting malunited intra-articular fractures of the base of the middle phalanx.
abstract: OBJECTIVE
  To present our results in the treatment of late-presenting impaction fractures of the base of the middle phalanx treated by osteotomy with full exposure of the articular surface to restore the normal anatomy.
  
  
  METHODS
  Eleven patients with a malunited (impacted) fracture of the base of the middle phalanx were treated by osteotomy more than 5 weeks after the injury. All fractures had varying degrees of impaction, comminution, and dorsal subluxation. The malunited joint surface was visualized by dislocating the joint by hyperextension (shotgun approach). The restoration of the cup-shape contour of the middle phalangeal base was accomplished by osteotomy and mobilization of small osteochondral fragments. Rigid fixation was performed by cerclage wire, screws, or a combination of these. A distal radius bone graft was placed beneath disimpacted fragments in 9 of the 11 procedures.
  
  
  RESULTS
  Ten of 11 patients were followed-up for more than than 1 year. One patient with a volar lateral impaction fracture was lost to follow-up study 4 weeks after the surgery and was excluded from the results. All patients except 1 achieved a functional range of motion of the proximal interphalangeal joint. Moderate limitations of the distal interphalangeal joint motion were common. Grip and thumb-affected finger tip pinch strengths were 95% and 90%, respectively, of the healthy side. The average pain level (as rated on a visual analog scale of 0-10) improved from a preoperative score of 9.1 to a postoperative score of 0.8. One patient was somewhat dissatisfied; all other patients were satisfied or very satisfied. All returned to their previous work at an average of 13 weeks after surgery.
  
  
  CONCLUSIONS
  Favorable results have been achieved in this challenging scenario in the short- and middle-term in 9 of 10 patients. Previous surgery and moderate to severe wearing of the cartilage of the proximal phalanx head negatively affected the results.
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa and Clínica Mompía, Santander, Spain. drpinal@ono.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Del Piñal
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: García-Bernal
authors.forename: Julio
authors.initials: J
authors.lastname: Delgado
authors.forename: Marcos
authors.initials: M
authors.lastname: Sanmartín
authors.forename: Javier
authors.initials: J
authors.lastname: Regalado
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000150:complications / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017759:Fractures, Malunited / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome