title: Predictors of Postoperative Finger Stiffness in Unstable Proximal Phalangeal Fractures.
abstract: BACKGROUND
  The purpose of this study was to determine the risk factors for postoperative finger stiffness after open reduction and internal fixation of unstable proximal phalangeal fractures using a low-profile plate and/or screw system. We hypothesized that dorsal plate placement is a risk factor for postoperative finger stiffness.
  
  
  METHODS
  Seventy consecutive patients (50 men, 20 women; average age, 40 years) with 75 unstable proximal phalangeal fractures were treated with titanium plates and/or screws and evaluated at a minimum follow-up of 1 year. Thirty-six comminuted fractures and 24 intra-articular fractures were included, and 16 fractures had associated soft-tissue injuries. Plate fixation was performed in 59 fractures, and the remaining 16 were fixed with screws only. The implants were placed in a dorsal location in 33 fractures and in a lateral or volar location in 42 fractures. Finger stiffness was defined as a total active range of finger motion <80% for the treated finger. Univariate and multivariate analyses were performed on 8 variables: patient characteristics (age and sex), fracture characteristics (fracture comminution, joint involvement, and associated soft-tissue injury), and surgical characteristics (type and location of implants and removal of the implants).
  
  
  RESULTS
  Postoperative finger stiffness occurred in 38 fractures. The multivariate analysis indicated that plate fixation (odds ratio, 5.9; 95% confidence interval, 1.5-24.0; P = 0.01) and dorsal placement (odds ratio, 3.0; 95% confidence interval, 1.1-8.3; P = 0.03) were independent risk factors for finger stiffness.
  
  
  CONCLUSIONS
  We recommend the use of screw fixation as much as possible for unstable proximal phalangeal fractures using a midlateral approach.
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Tadanobu
authors.initials: T
authors.lastname: Onishi
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Omokawa
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Fujitani
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Shigematsu
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan; Department of Orthopedic Surgery, Yao General Hospital, Yao, Japan; and Department of Orthopedic Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka