[Pseudarthrosis and delayed union of the distal phalanx of the long fingers. Apropos of 13 cases].

PURPOSE OF THE STUDY

The authors present 13 cases of delayed or non-union of the distal phalanx of the long fingers treated surgically.

MATERIAL AND METHODS

The patients were all men aged from 41 years to 60 years. The involved digits were 4 second, 2 long, 5 ring, and 2 little fingers. The operated side was the right side 5 times, the left one 8 times, the dominant one 4 times. Ten cases were due to inadequate treatment of the initial fracture. The three others cases had no clear explanation. Three types of incisions were used: transverse distal, lateral or an extended one combining the two previous. Bone stabilisation was made either, by longitudinal K wires or with a small cancellous screw. In 7 cases, bone grafting was needed.

RESULTS

Bone healing was obtained in 9 cases in an average time of 9 weeks. Further procedures included: 2 distal amputations after septic conditions, 2 removals of distal bone fragment and 2 fusions of the distal interphalangeal joint. Overall results evaluated by the patients themselves were fair, including 2 excellent, 6 good (but 2 after distal interphalangeal joint arthrodesis), 2 mild (1 after distal interphalangeal joint arthrodesis), 1 poor and 2 failures.

DISCUSSION

The type of skin incision was chosen according to the bone condition; distal in cases of fibrous nonunion when fibrous tissue removal and bone grafting were needed. Neither the type of bone stabilisation (pinning or screwing) nor the donor site of bone grafting influenced the final result.

CONCLUSION

The authors would like to stress the importance of an adequate treatment of finger injuries in a emergency situation, considering the difficulties to restore secondarily a satisfactory functional outcome.