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ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 103-112

Comparison of conservative and operative management for unstable extra articular proximal phalanx fracture of hand: A prospective study


Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India

Correspondence Address:
Dr. Ramesh Chandra Maharaj
Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOASP.JOASP_26_20

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BACKGROUND: Hand injuries are often overlooked and are not given the importance that they deserve. Decision-making in the management of phalangeal fractures is crucial rather more difficult than long bone fractures; as no treatment will lead to deformity and over treatment will cause stiffness. AIM OF THE STUDY: Compare the results of both conservative and operative managements of proximal phalangeal fractures for decision making while dealing with these innocent looking injuries. SUBJECTS AND METHODS: This was a prospective study of 60 patients of unstable extra articular proximal phalangeal fractures over 2 years. Fifty percent of the patients managed conservatively and 50% surgically. Results were analyzed by the assessment of total range of movements (TROM); functional score of Belesky et al.; grip strength; time of return to work and complications associated with each methods. RESULTS: There was no statistically significant difference between conservative and operative group (TROM P 0.063; Belesky score P = 0.135). Among all modalities best results was achieved with Close Reduction and Internal Fixation (CRIF) with percutaneous k wires which was statistically and clinically significant as compared to conservative and Open Reduction and Internal Fixation (ORIF) group (TROM P = 0.012; Belesky score P = 0.024]. Complications were mostly malunion with conservative methods and infection; implant failure; CRPS were more common in operative methods. CONCLUSION: Conservative management is preferred over surgery for unstable proximal phalangeal fractures. If surgery is needed for stability than close reduction (CRIF) with percutaneous k wire is preferred over open techniques (ORIF).


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