LOW-VELOCITY GUNSHOT WOUNDS OF THE PROXIMAL PHALANX - TREATMENT BY EARLY STABLE FIXATION

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.