Kurzen Peter, Fusetti Cesare, Bonaccio Mario, Nagy Ladislav
Division of Hand Surgery, University Hospital, Berne, Switzerland.
J Trauma. 2006 Apr;60(4):841-3. doi: 10.1097/01.ta.0000214887.31745.c4.
To assess the complications after plate fixation of phalangeal fractures, their correlation with the type of injury, and the outcome.
We retrospectively reviewed the clinical records and the x-rays of 54 consecutive patients with 64 phalangeal fractures treated by open reduction and plate fixation with regard to fracture healing, plate loosening or failure, infection, complex regional pain syndrome, pain, return to work, and range of motion.
In 31 out of 54 patients (57%) and 33 out of 64 fractures (52%), one or more major complications occurred. Stiffness (definition is composite range of motion of metaphalangeal, proximal interphalangeal, and distal interphalangeal joints added together equaling <180 degrees) contributed the highest number (22 patients, 24 fractures). The complication rates were not different whether the fracture was open or closed, if it was located in the proximal or middle phalanx, the presence or absence of an associated soft tissue lesion, and the patient's occupation.
In spite of early mobilization, stiffness is the most frequent complication after open reduction and plate fixation of phalangeal fractures. The undue amount of scarring and adhesion may arise from the implant itself or the difficulty in finding the perfect mixture between the minimal surgical invasiveness and a sufficient restoration of skeletal stability. Otherwise, plate fixation of unstable and complex phalangeal fractures proved efficient and reliable, although not free of potential problems.
评估指骨骨折钢板固定术后的并发症、其与损伤类型的相关性及预后。
我们回顾性分析了54例连续患者的64例指骨骨折的临床记录及X线片，这些患者均接受切开复位钢板固定治疗，评估指标包括骨折愈合情况、钢板松动或断裂、感染、复杂性区域疼痛综合征、疼痛、恢复工作情况及活动范围。
54例患者中有31例（57%）、64例骨折中有33例（52%）发生了一种或多种主要并发症。僵硬（定义为掌指关节、近端指间关节和远端指间关节的综合活动范围相加小于180度）的发生率最高（22例患者，24处骨折）。无论骨折是开放性还是闭合性、位于近端指骨还是中间指骨、有无合并软组织损伤以及患者职业如何，并发症发生率均无差异。
尽管早期进行了活动，但僵硬仍是指骨骨折切开复位钢板固定术后最常见的并发症。过多的瘢痕形成和粘连可能源于植入物本身，也可能是由于难以在最小手术创伤和充分恢复骨骼稳定性之间找到完美的平衡。否则，对于不稳定和复杂的指骨骨折，钢板固定虽并非没有潜在问题，但已证明是有效且可靠的。
