[Depressed fractures of the base of the middle phalanges of the fingers : Evaluation of a percutaneous, intramedullary surgical technique]. / Mittelgliedbasisimpressionsfrakturen der Finger : Evaluation eines perkutanen, intramedullären Operationsverfahrens.

ABSTRACT

BACKGROUND: Depressed fractures of the base of the middle phalanges are problematic because of frequent subluxations and centrally depressed fragments. There are two minimally invasive procedures available 1) the less known intramedullary padding technique according to Hintringer and 2) the widely used distraction fixator of Suzuki. This article describes the technique and outcome of these two procedures. METHODOLOGY: The follow-up collective included 42 patients after treatment of a depressed fracture of the base of the middle phalanx. An intramedullary padding with percutaneous Kirschner wire retention was performed 28 times (group A) and treatment with a Suzuki fixator 14 times (group B). The study examined the hand function, the radiological results and the subjective pain level. RESULTS: According to the American Society for Surgery of the Hand (ASSH) classification 81% of the patients in group A achieved a good result but in group B the same result was achieved by only 50% of the patients. The median range of movement in the proximal interphalangeal joint was 82.5° after intramedullary padding and 47.5° after Suzuki fixator. In median, the impression was reduced from 2.35 mm to 0.5 mm in group A, but only from 1.6 mm to 1.15 mm in group B. Pain was a limiting factor in 2 out of 28 patients in group A and 1 out of 14 patients in group B. CONCLUSION: The intramedullary padding technique according to Hintringer enables good treatment of depressed fractures of the base of the middle phalanx of the finger. Repositioning of dorsal subluxations can be performed and centrally impressed fragments can be reduced better than by using the Suzuki dynamic fixator. In addition, the radiological course assessments can be assessed better than with the distraction fixator.