External fixation of open comminuted fractures of the proximal phalanx.

External fixation is an accepted method of treatment for many injuries, however, only a limited number of reports concern its use in open, comminuted fractures of the hand. Ten patients with eleven fractures of the proximal phalanx were treated using the AO/ASIF small external fixator. Five fractures involved the interphalangeal joint (IPJ), two the metacarpophalangeal joint (MPJ), and four the shaft. Nine fractures were caused by small caliber gunshot wounds, one was due to a power saw injury, and one occurred during a three wheeler accident. The patients with interphalangeal joint involvement all had extensive involvement of one or both of the joint surfaces. The fixator was placed across the joint and a stable ankylosis allowed to occur with the IPJ in 30 degrees to 40 degrees of flexion. MPJ motion averaged 75 degrees in these patients while distal interphalangeal joint (DIPJ) motion averaged 20 degrees. The four patients with shaft fractures all healed, but three required bone grafting. These patients averaged 85 degrees of MPJ motion, 25 degrees of proximal interphalangeal joint (PIPJ) motion, and 30 degrees of DIPJ motion. One patient with metacarpophalangeal joint involvement regained 85 degrees of MPJ motion but had limited motion at the PIPJ and DIPJ. The other patient with MPJ involvement suffered massive bone loss; a ray amputation was eventually performed. Complications included pin tract drainage in three of the eleven fractures and slight loss of reduction in two fractures. The best clinical results occurred when the fixator was used as a digit salvage procedure in interphalangeal joint fractures.(ABSTRACT TRUNCATED AT 250 WORDS)