Percutaneous Pinning of Fractures in the Proximal Third of the Proximal Phalanx: Complications and Outcomes

Department of Orthopedic Surgery, Division of Hand Surgery, Naval Medical Center Portsmouth, Portsmouth, VA 237008-2197, USA.
The Journal of hand surgery (Impact Factor: 1.67). 07/2012; 37(7):1342-8. DOI: 10.1016/j.jhsa.2012.04.019
Source: PubMed


Two common techniques for fixation of extra-articular fractures at the proximal phalanx base are transarticular (across the metacarpophalangeal joint) and extra-articular cross-pinning. The aim of this study was to assess the complications and outcomes of these 2 techniques. Our hypothesis was that transarticular and extra-articular closed reduction and percutaneous pinning of base of proximal phalanx fractures have similar complication rates and outcomes.
A retrospective chart review identified 338 patients with base of proximal phalanx fractures. We treated 50 isolated fractures with closed reduction and percutaneous pinning using 1 of 2 techniques: transarticular (25 fractures through the metacarpal head) or extra-articular (25 fractures cross-pinned through the base of the proximal phalanx). Outcome measures included total active motion and complications.
We found a substantial overall complication rate in both groups. The mean total active motion for the transarticular group and cross-pinning group was 201° and 198°, respectively. Proximal interphalangeal joint motion was notably affected; nearly half of the patients in each group had flexion loss greater than 20° (average, 27°) at the proximal interphalangeal joint. Nearly a third of patients in both groups had fixed flexion contracture greater than 15° at the proximal interphalangeal joint. There were more secondary procedures in the transarticular group (6) than in the cross-pinning group (2). There was no statistical significance between groups in any of the outcome parameters used.
Closed pinning minimizes additional soft tissue injury and allows for early motion, but neither fixation method was superior in terms of the measured parameters. In addition, overall results were not as good as what has been reported in the literature.

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