Finger fractures: Epidemiology and treatment based on 21341 fractures from the Swedish Fracture register.

BACKGROUND: There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity. METHODS: Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs). RESULTS: The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality of life and there were no relevant differences in PROMs between fracture type, treatment, or sex. CONCLUSION: This study presents detailed information about the various types of finger fractures which can be used as point of reference in clinical work and for future studies.

Dynavisc as an Adhesion Barrier in Finger Phalangeal Plate Fixation-a Prospective Case Series of 8 Patients.

Purpose: Adhesion problems are common after plate fixation of finger phalanges and often lead to stiffness and reoperations with plate removal and tenolysis. The aim of this prospective case series was to study the effect of the adhesion barrier gel Dynavisc on total active motion (TAM), postoperative pain, and grip strength after plate fixation of phalangeal fractures. Total active motion at 3 months after surgery was the primary outcome. Methods: Eight patients with a fracture of the proximal phalanx underwent surgery with open reduction and plate fixation. The adhesion barrier Dynavisc was applied between plate and extensor tendon and between tendon and skin. Results in terms of pain, grip strength, and TAM at 2 weeks, 3 months, and 1 year after surgery were collected. Results on TAM were classified according to Page and Stern. Results: After 3 months, only 2 patients had a result classified as excellent. After 1 year, 3 patients fulfilled the criteria for an excellent result. There were no adverse events. Patients with long-standing postoperative pain had a worse outcome on TAM. Conclusions: The antiadhesive effect of Dynavisc in this prospective case series was unconvincing. Only 2 patients had an excellent result on TAM at 3 months. Because the gel is resorbed within 30 days after application, it is questionable whether the gel had a role in improvement that occurred later in the postoperative course. Larger, randomized studies would be required to show any anti-adherent effect of Dynavisc definitively in finger fracture surgery. Type of study/level of evidence: Therapeutic IV.

Reoperations and postoperative complications after osteosynthesis of phalangeal fractures: a retrospective cohort study.

OBJECTIVES: The aim of the study was to describe the reoperation rates and postoperative complications associated with different methods of osteosynthesis in all extra-articular, closed fractures of the proximal and middle phalanges operated on in the Department of Hand Surgery at Södersjukhuset beween 2010-2014, and to describe the associated patient demographics. PATIENTS AND METHODS: This study included all the relevant operations, which comprised operations on 181 fractures in 159 patients (82 male, 77 female), median and mean age = 43 (range = 14-88 years). The clinical records and radiographs were examined retrospectively. A logistic regression analysis was performed on the reoperation data to determine which method of osteosynthesis was the most important descriptor for reoperation, and whether the fracture type was a significant confounder. RESULTS: Forty-seven patients (26%) were reoperated on, mainly due to finger stiffness. The reoperation rates were 25% after K-wire, 15% after screws, and 42% after plate fixation. The unadjusted reoperation rate after plate fixation was significantly higher than for the other methods, but not after adjustment for fracture complexity. The proximal phalanx was affected in 88% of the fractures, and 77% were located in the fourth or fifth finger. Falls, animal-related, and sports injuries were the most frequent causes of injuries. CONCLUSION: Open reduction with plate fixation was associated with a higher reoperation rate, but this method was also used for the more complex fractures. Plate fixation for phalangeal fractures often entails a need for later tenolysis and plate removal. More aggressive mobilisation regimes might be indicated to prevent adhesion problems.

Treatment of a large aneurysmal bone cyst in a 15-year-old boy using a corticospongial bone graft and a 12-year follow-up after operation.

We report the case of a 15-year-old boy with a large aneurysmal bone cyst in the third metacarpal, which was operated on radically with excision of the bone and grafting from the distal radius. At 12-year follow-up the patient had good cosmetic results and a perfectly functioning hand.

Assessment of the severity of injuries to hands by powered wood splitters.

Our aim was to rate the severity of injuries to hands by powered wood splitters. The patients were identified from a computerised registry, and the cause of injury was confirmed by written questionnaire and structured telephone interview. Information about the anatomy of the injury was gathered from patients' records and radiographs. Severity of injury was rated according to the Hand Injury Severity Scoring System (HISS system) and the Injury Severity Score (ISS). The reliability of HISS rating was tested. The mean Hand Injury Severity Score (HISS) was 63 and the mean ISS was 3.7. Twenty-five (19%) of patients had minor, 41 (31%) had moderate, 30 (23%) had severe, and 35 (27 %) had major injuries when scored by the HISS system. Children's injuries were more severe than those of adults. There was no difference in severity between injuries made by wedge and screw splitters. It is not possible to avoid serious hand injuries from powered wood splitters completely by prohibiting one of the two main types of splitter.