Desaldeleer-Le Sant A-S, Le Sant A, Beauthier-Landauer V, Kerfant N, Le Nen D
Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France.
Service de Chirurgie Orthopédique et Traumatologique, Centre hospitalier des Pays de Morlaix, Rue de Kersaint Gilly, 29600 Morlaix, France.
Hand Surg Rehabil. 2017 Apr;36(2):127-135. doi: 10.1016/j.hansur.2016.08.009. Epub 2017 Feb 7.
Finger fractures are the most common skeletal injuries of the upper limbs. The purpose of this study was to evaluate the functional outcomes and complications after surgical management of isolated, closed fractures of the proximal phalanx (PP) of the hand (thumb excluded). Surgical management was indicated in 87 PP fractures. Fractures were reduced and fixed with pins, screws or a plate. Functional outcomes were assessed through the range of motion (ROM) in flexion-extension, hand and finger strength, and the QuickDASH and PRWHE scores. Fixation was done with pins in 32 cases, screws in 41 cases, and a plate in 14 cases. Rehabilitation was started an average of 1.7 weeks after surgery. There was no significant difference in the functional outcomes based on either fracture type or surgical approach. Nevertheless, the following significant differences were observed: PRWHE score (P=0.017) by injured finger; proximal interphalangeal (PIP) ROM (P=0.037) by fixation type; and grip strength (P=0.019), Quick DASH (P=0.017), and PRWHE (P=0.045) by rehabilitation delay. The most common clinical complications were minor malrotation and cold intolerance. Radiological assessment showed complete union in all cases. Surgical management of PP fractures leads to good functional outcomes, including a satisfactory recovery of finger ROM. The functional recovery of a fractured digit is dependent on the right fixation choice, complete bone union, and early rehabilitation. We suggest using screw fixation to achieve patient satisfaction and optimal functional recovery of closed, isolated PP fractures of the long fingers.
手指骨折是上肢最常见的骨骼损伤。本研究的目的是评估手部近端指骨（不包括拇指）孤立性闭合骨折手术治疗后的功能结局和并发症。87例近端指骨骨折患者接受了手术治疗。骨折采用克氏针、螺钉或钢板复位固定。通过屈伸活动范围（ROM）、手部和手指力量以及QuickDASH和PRWHE评分评估功能结局。32例采用克氏针固定，41例采用螺钉固定，14例采用钢板固定。术后平均1.7周开始康复治疗。基于骨折类型或手术方式的功能结局无显著差异。然而，观察到以下显著差异：受伤手指的PRWHE评分（P = 0.017）；固定类型不同，近端指间关节（PIP）的ROM（P = 0.037）不同；康复延迟对握力（P = 0.019）、Quick DASH（P = 0.017）和PRWHE（P = 0.045）有影响。最常见的临床并发症是轻度旋转不良和不耐寒。影像学评估显示所有病例均完全愈合。近端指骨骨折的手术治疗可带来良好的功能结局，包括手指ROM的满意恢复。骨折手指的功能恢复取决于正确的固定选择、完全骨愈合和早期康复。我们建议使用螺钉固定以实现患者满意度和长手指闭合性、孤立性近端指骨骨折的最佳功能恢复。
