Plastic Surgery Research Council
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Presenter: Lisa Ng, MBBS
Co-Authors: Thomson S; Howarth D; Coutinho M; Rannan-Eliya S.
Department of Burns and Plastic Surgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP United Kingdom

Acknowledgement: This presentation was presented in August 2012 at the EPSRC (Hamburg / Germany) and was awarded best poster prize of the meeting.

BACKGROUND: Phalangeal fractures account for around 10% of all fractures. External fixation is routinely used to stabilise complex fracture patterns avoiding the need to open the soft tissues, or where fracture configurations preclude internal fixation, such as some complex hand injuries. Many commercial devices have been developed; however, these fixators can be expensive and require a degree of familiarity with their use. Here we describe our unit’s experience using a simple external fixator constructed using materials readily available in the operating theatre. This device was introduced to our department by our Associate Specialist Hand Surgeon and the technique has been used widely by other surgeons within the department. A recent medical student audit had suggested that functional outcomes are improved when the procedure is undertaken by this surgeon.

METHODS: The technique is described and functional outcomes are discussed. All patients undergoing external fixation for phalangeal fractures over a five-year period were identified from theatre logbooks. Data was obtained retrospectively on aetiology, fracture configuration, operative details, complications and post-operative function using previously validated Total Active Movement (TAM) scores. Post-operative function in patients whose surgery was performed by the introducing surgeon was compared to those whose surgery was performed by other plastic surgeons in the department.

RESULTS: A total of 52 patients undergoing external fixation were identified. Of these it was possible to retrieve post-operative functional outcome measurements in 38 patients. Injuries were sustained secondary to an altercation(n=9), crush(n=11) or fall onto hand(n=17). The majority of fractures sustained affected the little finger (n=22) and the proximal phalanx (n=28) was the bone most commonly injured. Twenty-six patients had their surgery performed by the Associate Specialist (AS), ten by registrars and one by a consultant. Complications occurred in 9/26 in the AS group and 4/11 in the “Other group”. These were unexpected stiffness (n = 4), unexpected swelling (n = 4) or pin site infection (n=5). No secondary procedures were required, and all patients achieved bone union. Functional outcome data over a follow up period of 1 months to six months was available (mean = 2.2 months). At four months a ‘good’ clinical result (mean TAM > 230o) was achieved overall in the AS group, compared to a mean of 162o in the “Other” group.

CONCLUSION: This novel external fixator device provides a reliable and cost-effective method of fracture fixation in experienced hands. Functional outcomes are favourable when compared to other methods of phalangeal fracture fixation. This series represents the largest number of cases of external fixation of phalangeal fractures in the literature. Although limited by the presence of many confounding variables within relatively small cohorts, this study would suggest also that functional outcomes are improved when the surgery is performed by Associate Specialists in our department.

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