IMPENDING MALUNIONS OF THE HAND - TREATMENT OF SUBACUTE, MALALIGNED FRACTURES

Malunions of the hand present a challenging problem to the orthopaedic surgeon, Angular and rotational deformities, and shortening and artic ular incongruity, can lead to significant functional impairment or dys esthetic appearance, The prevention of malunion should remain a primar y goal.(2,6) When displaced fractures of the metacarpals or phalanges present within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation are exc ellent options with predictable results, Malaligned fractures that pre sent later frequently cannot be readily reduced, Once fully united, tr eatment options have included corrective osteotomy if function is sign ificantly impaired or if appearance is objectionable; for patients who are not suitable for surgery for medical or other reasons, or for who m appearance is acceptable, intensive occupational therapy to maximize function may yield sufficiently serviceable clinical results, During the past several years, the senior author (BL) has chosen to be more p roactive in the prevention of malunions of the hand, Zn the authors' e xperience, results of aggressive surgical treatment of subacute, malal igned fractures in selected patients have produced results comparable with or superior to those reported for later reconstructive procedures , With the proliferation of managed care, there has been an increasing frequency of delayed referral patterns for fracture treatment by hand specialists, Definitive treatment of these ''impending malunions'' is preferable to passive treatment delay and secondary reconstructive pr ocedures, offering both earlier correction of alignment and earlier op portunity for return of function.