Patient-Reported Outcomes and Complications After Surgical Fixation of 143 Proximal Phalanx Fractures.

Autor:	Kootstra TJM; Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands. Electronic address: tom_kootstra@live.nl., Keizer J; Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands., Bhashyam A; Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Houwert RM; Department of Surgery, Universitair Medisch Centrum, Utrecht, The Netherlands., Verleisdonk EMM; Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands., van Heijl M; Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands; Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands., van der Velde D; Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2020 Apr; Vol. 45 (4), pp. 327-334. Date of Electronic Publication: 2019 Oct 02.
DOI:	10.1016/j.jhsa.2019.08.010
Abstrakt:	Purpose: Multiple methods exist to surgically fix unstable phalangeal fractures. Whereas these methods have different rates of complications or reoperation, it is not known whether these differences lead to changes in patient reported outcome. We compared patient-reported outcomes measures and complications of Kirschner wire (K-wire), lag-screw and plate fixation of proximal phalanx fractures (excluding the thumb). Methods: From 2010 to 2015, 159 patients with 159 proximal phalanx fractures were identified in 2 level 2 trauma centers and fixed with K-wires (44% of patients), lag-screws (26%), or plates (30%). Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) and complications were assessed. In addition, subjective outcomes were assessed. Follow-up was achieved for 143 fractures (90%) and average time to follow-up was 3.4 years. Results: Mean DASH and PRWHE scores were 5.0 and 8.2, respectively. No differences in functional outcomes were found between fixation methods, although unplanned reoperation was more common in the plate fixation group (9 patients; 21%) than in the K-wire and lag-screw fixation groups (3 patients and 1 patient; 4.8 and 2.7%, respectively). We also found that K-wire fixation was associated with better aesthetic outcome than open reduction internal fixation. Conclusions: Overall patient-reported outcomes measure scores were similar across fixation methods, and unplanned reoperation was more prevalent after plate fixation. In addition, we found that regardless of fracture pattern, percutaneous fixation with K-wires was often sufficient and associated with better aesthetic outcome than open reduction and internal fixation. Type of Study/level of Evidence: Prognostic IV. (Copyright © 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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