title: Treatment of extra-articular proximal and middle phalangeal fractures of the hand: a systematic review.
abstract: The aim of the study was to systematically review the patient reported and functional outcomes of treatment for extra-articular proximal or middle phalangeal fractures of the hand in order to determine the best treatment options. The review methodology was registered with PROSPERO. A systematic literature search was conducted in electronic bibliographic databases. Two independent reviewers performed screening and data extraction. The evaluation of quality of the included studies was performed using the Structured Effectiveness Quality Evaluation scale. The initial search yielded 2354 studies. The full text manuscripts of 79 studies were evaluated of which 16 studies met the inclusion criteria. In total, 513 extra-articular proximal and middle phalangeal fractures of the hand were included of which 118 (23%) were treated non-operatively, 188 (37%) were treated by closed reduction internal fixation (CRIF) and 207 (40%) by open reduction internal fixation. It can be recommended that closed displaced extra-articular phalangeal fractures can be treated non-operatively, even fractures with an oblique or complex pattern, provided that closed reduction is possible and maintained. Conservative treatment is preferably performed with a cast/brace allowing free mobilization of the wrist. No definite conclusion could be drawn upon whether closed reduction with extra-articular K-wire pinning or transarticular pinning is superior; however, it might be suggested that extra-articular K-wire pinning is favoured. When open reduction is necessary for oblique or spiral extra-articular fractures, lag screw fixation is preferable to plate and screw fixation. But, similar recovery and functional results are achieved with transversally inserted K-wires compared to lag screw fixation.
  
  
  METHODS
  therapeutic III.
authors.affiliation: Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. d.verver@erasmusmc.nl.|Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands. d.verver@erasmusmc.nl.
authors.forename: D
authors.identifier: http://orcid.org/0000-0003-0034-3575
authors.initials: D
authors.lastname: Verver
authors.affiliation: Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Timmermans
authors.affiliation: Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Klaassen
authors.affiliation: Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vlies
authors.affiliation: Department of Surgery, Amphia Hospital, P.O. Box 90157, 4800 RL, Breda, The Netherlands.
authors.forename: D I
authors.initials: DI
authors.lastname: Vos
authors.affiliation: Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands.
authors.forename: N W L
authors.initials: NWL
authors.lastname: Schep
keywords: Extra-articular phalangeal fractures; Fracture treatment; ORIF; Systematic review