title: Plate fixation of extra-articular fractures of the proximal phalanx: do new implants cause less problems?
abstract: BACKGROUND
  Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems.
  
  
  METHODS
  From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS).
  
  
  RESULTS
  No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total active finger motion (TAM) averaged 183°, and all 32 patients underwent formal hand therapy. At the latest follow-up or at the time of plate removal, respectively, the mean TAM improved to 213°. Extension lag of proximal interphalangeal joints was found in 67 % of all fractured fingers. Secondary surgery was necessary in 14 of 32 patients (2 corrective osteotomies, 12 plate removals including 7 procedures explicitly because of reduced mobility).
  
  
  CONCLUSIONS
  Despite of new implant designs significant problems persist. Adhesions of extensor tendons leading to limited range of finger motion are still the most frequent complications after ORPF of proximal phalangeal fractures, even in absence of significant soft-tissue damage.
  
  
  METHODS
  Therapeutic, Retrospective, Level IV.
authors.affiliation: Department of Plastic and Hand Surgery, Inselspital Bern, Bern, Switzerland.
authors.forename: Pascale
authors.initials: P
authors.lastname: Brei-Thoma
authors.forename: Esther
authors.initials: E
authors.lastname: Vögelin
authors.forename: Torsten
authors.initials: T
authors.lastname: Franz
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D050278:Finger Phalanges / Q000293:injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D055815:Young Adult