Viswanathan, M S (2006) Management of proximal phalangeal fractures of hand: Role of long aluminium splint immobilization. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Phalangeal fractures are the most common fractures of upper extremities. It accounts for approximately 1/3 of fractures involving the hand. Outer rays of hand especially thumb and little fingers are most commonly involved. These are often neglected or regarded as trivial injuries. “Hand fractures can be complicated by deformity from no treatment, stiffness from over treatment, both deformity and stiffness from poor treatment.” -Swanson. This aphorism is true and must the always kept in mind while treating these Fractures. In our country where in population is high, and working class is employed in industries with minimal or no protective measures and poor working environment, the incidence of these injuries are high. Losses resulting from these in terms of days of restricted activity and days off work are very significant. Success of management depends on the type of fracture, good patient motivation apart from surgical skill. Goal of treatment is to have full and rapid restoration of function. Incidence of these fractures is so high, and disability resulting from it so crippling if improperly managed, inspired this study. AIMS OF THE STUDY: 1. To study the Epidemiology of proximal phalangeal fractures. 2. To review various modalities of management of proximal phalangeal fractures as practiced in our Institute 3. Evaluate the results of proximal phalangeal fractures management 4. Compare the Functional outcome of Long Aluminium Splint Immobilization of these fractures as compared with other modalities MATERIALS AND METHODS: This study consists of evaluation of all proximal phalanx fractures seen in our department for 1 year from March 2004 to March 2005. (Replantation through proximal phalanx were not included). This combined prospective & retrospective study included analysis of age, sex, nature of injury socioeconomic status, number of fingers injured, ray involved, type of fracture, associated injuries to adjacent structures, pre and post operative x-rays, type of fracture fixation, evaluation of post operative results and management of secondary complications. Patients were followed up after a period of 3 months. Evaluation of results was done using criteria proposed by Buchler et. al. (1996). Protocol of Management: The various methods adopted for management of cases are techniques used in our Institute. Indication for Conservative Treatment: This consists of closed reduction and POP immobilization. Indications are: 1. Undisplaced intra or extraarticular fractures stable after reduction. 2. Severe injuries with doubtfully viable fingers. 3. Severe comminuted fracture. Indication for Long Aluminium Splint Immobilization (L.A.S.I): 1. Simple fracture transverse or oblique of shaft or base of proximal phalanx 2. Compound noncomminuted fracture involving single finger 3. Selected intraarticular fractures with severe communion. Indication for K-Wire Fixation or S.S.Wire Fixaton: 1. Irreducible fractures, 2. Malrotation (spiral and short oblique), 3. Intraarticular fractures, 4. Subcapital fractures, 5. Open fractures, 6. Segmental bone loss (K-wire spacer), 7. Polytrauma with hand fractures, 8. Multiple hand or wrist fractures, 9. Fracture with soft-tissue injury (vessel, tendon, nerve, skin). CONCLUSION: CONSERVATIVE TREATMENT 1. It is ideal for management of patients with multiple injuries, comminuted fractures and those with vascular problems 2. The over all results of conservative management are poor in terms of final outcome results. This could be due to indications for this line of management which chooses those with severe injuries involving the soft tissue envelop. Long Aluminium Splint Immobilization: 1. It is most simple least invasive procedure 2. It does not require sophisticated bone instruments or manipulation. 3. It is cheap in terms of raw materials which include: aluminum splint which can be easily procured cheaply, POP, Prolene suture, & bandage materials. 4. It is a technically easier procedure compared with other methods of internal fixation. 5. It does not take more than 30 minutes to complete the procedure. 6. It is ideally suited for simple fractures of proximal phalanx involving one or more fingers or compound fractures involving single finger. 7. Post application manipulation of fracture if reduction not ideal is very easy. It is not possible in any other method of management. 8. Post operative results are excellent in more than 80% of patients, poor results are rarely seen. 9. Number of complications needing secondary procedures is much less when compared with other methods of management. 10. This procedure has a fast learning curve. Results obtained in hands of even a beginner are good. 11. This procedure allows a larger margin of error which can be easily rectified. 12. Drawbacks however are patient compliance is less due to splint projecting in front of finger. It is also prone to injuries which can jeopardize the fracture immobilization. Nail injuries, prolene suture cutting away are rarely seen. None were encountered in this series K-Wire Fixation & S.S.Wire Fixation: 1. This procedure is ideal for compound fractures involving multiple fingers or hand 2. It is technically difficult 3. Margin of error is less 4. It needs specialized bone equipments – drills and K-wires 5. Injuries to adjacent soft tissue envelop to skin, tendons vessels and nerve is significant. this compromises in the final outcome 6. Injuries to joint articular surface while introduction is common. this could be one of the reasons for post operative stiffness. 7. Functional outcome of management by this method shows good and fair results in 75% of the patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Management ; proximal phalangeal fractures ; hand ; long aluminium splint immobilization. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:40 |
| Last Modified: | 12 Oct 2017 01:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3424 |
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