Mh. Gonzalez et al., LOW-VELOCITY GUNSHOT WOUNDS OF THE PROXIMAL PHALANX - TREATMENT BY EARLY STABLE FIXATION, The Journal of hand surgery, 23A(1), 1998, pp. 150-155
Twenty-eight proximal phalangeal fractures secondary to low-velocity g
unshot wounds in 27 patients treated by stable fixation were retrospec
tively reviewed. Definitive fixation was performed within 1 week oi in
jury. Fractures were stabilized with either a plate, intramedullary sp
acer, or a combination of both. When necessary, supplemental fixation
was achieved with cerclage wires or interfragmentary screws. Twenty fr
actures with bone loss or comminution were primarily supplemented with
iliac crest bone graft. After surgery, the fingers were splinted in 9
0 degrees of metacarpophalangeal (MP) flexion. An aggressive supervise
d therapy program was initiated within 24 hours of surgery. The averag
e length of follow-up care was 9 months (range, 3-29 months). Primary
union was achieved in ail fractures. The average range of motion was 8
3 degrees for the MP joint and 66 degrees for the proximal interphalan
geal joint. The average total active motion (TAM) far the involved dig
its was 200 degrees (range, 65 degrees-250 degrees). Fractures without
intra-articular extension had a significantly better average TAM (213
degrees) than did those with intra-articular extension (169 degrees;
p = .05). Primary hone grafting did not adversely effect the final TAM
, There were no infections. Early stable fracture fixation of these in
juries achieved union, alignment, and early rehabilitation with no app
reciable increase in morbidity. Copyright (C) 1998 by the American Soc
iety for Surgery of the Hand.