Locarno's Regional Hospital, Switzerland.
Locarno Hand Center, Switzerland.
Hand (N Y). 2022 Jul;17(4):691-700. doi: 10.1177/1558944720963894. Epub 2020 Oct 17.
Extensor tendon adhesions occurring after proximal phalangeal (P1) fractures are not uncommon. A previous report described the use of an adipofascial flap (AFF) to prevent adhesions after dorsal plating of the P1. The purpose of the study is to examine the results of open reduction and internal fixation with the use of an AFF (F group) and without (N group, that is, no flap used) in a larger group of patients.
A retrospective study involving a period of 11 years was conducted involving results of 21 unstable fractures of the P1 of the fingers in 18 patients. In all, 12 fingers were treated without any flap (N group) and 9 fingers were treated with the AFF (F group). For each patient, the total active motion (TAM) ratio, and the grip strength (Jamar) ratio were assessed, and adverse effects and the 10-point visual analogue scale (VAS) score were recorded. For statistical analysis, sample characteristics were described using mean ± standard deviation and median, and a Bayesian approach was used for inferential analysis.
In the F group, the TAM ratio (84% ± 13% vs 65% ± 17%) was higher with a lower rate of adverse effects (OR: 0.067, 95% CI, 0.0035-0.58,) and a lower VAS score with evidence of the positive effect of the AFF. The Jamar ratio was similar in the 2 groups (F group 80% ± 25% vs N group 79% ± 19%) with no associated effect of the AFF on grip strength.
The AFF is a reliable tool to reduce adhesions between plates and the extensor apparatus of the P1 and may be useful to improve finger function after plating of P1 fractures.
TYPE OF STUDY/LOE: Therapeutic, Retrospective, Level IV.
近节指骨（P1）骨折后发生伸肌腱粘连并不少见。先前有报道描述了使用脂肪筋膜瓣（AFF）来防止 P1 背侧钢板固定后的粘连。本研究的目的是在更大的患者群体中检查使用 AFF 进行切开复位内固定（F 组）和不使用（N 组，即未使用皮瓣）的结果。
进行了一项回顾性研究，涉及 18 名患者的 21 个不稳定的手指 P1 骨折，共 12 个手指未使用任何皮瓣（N 组），9 个手指使用 AFF（F 组）治疗。对每位患者的总主动活动度（TAM）比值和握力（Jamar）比值进行评估，并记录不良事件和 10 分视觉模拟评分（VAS）。统计分析采用均值±标准差和中位数描述样本特征，并采用贝叶斯方法进行推断分析。
在 F 组中，TAM 比值（84%±13%比 65%±17%）更高，不良事件发生率更低（比值比：0.067，95%CI：0.0035-0.58），VAS 评分更低，表明 AFF 有积极作用。两组的 Jamar 比值相似（F 组 80%±25%比 N 组 79%±19%），AFF 对握力无相关影响。
AFF 是减少 P1 钢板与伸肌装置之间粘连的可靠工具，可能有助于改善 P1 骨折钢板固定后的手指功能。
研究类型/证据等级：治疗性、回顾性、IV 级。
