DELAYED UNIONS AND NON-UNIONS OF THE DIST AL PHALANX - A REVIEW OF 13CASES

Purpose of the study The authors present 13 cases of delayed or non-un ion of the distal phalanx of the long fingers treated surgically. Mate rial and Methods The patients were all men aged from 41 years to 60 ye ars. The involved digits were 4 second, 2 long, 5 ring, and 2 little f ingers. The operated side was the right side 5 times, the left one 8 t imes, the dominant one 4 times, Ten cases were due to inadequate treat ment of the initial fracture. The three others cases had no clear expl anation. Three types of incisions were used :transverse distal, latera l or an extended one combining the two previous. Bone stabilisation wa s made either, by longitudinal K wires or with a small cancellous scre w. In 7 cases, bone grafting was needed. Results Bone healing was obta ined in 9 cases in an average time of 9 weeks. Further procedures incl uded : 2 distal amputations after septic conditions, 2 removals of dis tal bone fragment and 2 fusions of the distal interphalangeal joint. O verall results evaluated by the patients themselves were fair, includi ng 2 excellent, 6 good (but 2 after distal interphalangeal joint arthr odesis), 2 mild (1 after distal interphalangeal joint arthrodesis), 1 poor and 2 failures. Discussion The type of skin incision was chosen a ccording to the bone condition; distal in cases of fibrous nonunion wh en fibrous tissue removal and bone grafting were needed. Neither the t ype of bone stabilisation (pinning or screwing) nor the donor site of bone grafting influenced the final result. Conclusion The authors woul d like to stress the importance of an adequate treatment of finger inj uries in a emergency situation, considering the difficulties to restor e secondarily a satisfactory functional outcome.