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Reoperative Phalangeal and Metacarpal Fracture Management

  • Kane L. Anderson
  • Douglas P. HanelEmail author
Chapter

Abstract

The phalangeal or metacarpal fracture that has undergone previous surgery but resulted in nonunion, malunion, or posttraumatic arthritis can be particularly challenging. These fingers are usually stiff and sometimes painful to the patient. Besides the bone injury, there are usually soft-tissue problems that complicate the reconstructive efforts. For the PIP and MCP joints, arthroplasty and fusion remain as options for posttraumatic reconstruction. The use of osteotomies can be helpful addressing rotational or angular deformities. Hemi-hamate arthroplasty is a novel and useful technique for salvaging the failed unstable PIP fracture dislocation. Ultimately, if the digit cannot be reconstructed or if the digit becomes chronically stiff and painful, some patients will elect to have amputation as their final surgery to try and restore functionality to the hand and in order to get on with their lives.

Keywords

Phalangeal Metacarpal Fracture Reoperation Failed Surgery 

References

  1. 1.
    Carroll RE. Arthrodesis of the carpometacarpal joint of the thumb. A review of patients with a long postoperative period. Clin Orthop. 1987;220:106–10.PubMedGoogle Scholar
  2. 2.
    Burton RL, et al. Small joint arthrodesis in the hand. J Hand Surg. 1986;11A:678–82.Google Scholar
  3. 3.
    Steiger VR, Segmuller G. [Arthrodesis of the metacarpophalangeal joint of the thumb]. Handchir Mikrochir Plast Chir. 1989;21:18–22.PubMedGoogle Scholar
  4. 4.
    Saldana MI, Clark EN, Aulicino PL. The optimal position for arthrodesis of the metacarpophalangeal joint of the thumb: a clinical study. J Hand Surg. 1987;12B:256–9.Google Scholar
  5. 5.
    Ijsselstein CB, van Egmond DG, Hovius SER, van der Meulen IC. Results of small joint arthrodesis. Comparison of Kirschner wire fixation with tension band wire technique. J Hand Surg. 1992;17A:952–6.Google Scholar
  6. 6.
    Bamberger BH, Stern PI, Kiefhaber TR, McDonough JJ, Cantor RM. Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg. 1992;17A:605–11.Google Scholar
  7. 7.
    Hartigan B, Stern P, Kiefhaber T. Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am. 2001;83A:1470–8.Google Scholar
  8. 8.
    Hagan HJ, Hastings II H. Fusion of the thumb metacarpophalangeal joint to treat posttraumatic arthritis. J Hand Surg Am. 1988;13(5): 750–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Kovach IC, Wemer FW, Palmer AK, Greenkey S, Murphy DI. Biomechanical analysis of internal fixation techniques for proximal interphalangeal joint arthrodesis. J Hand Surg. 1986;11A:562–6.Google Scholar
  10. 10.
    Lewis RC, Nordyke MD, Tenny JR. The tenon method of small joint arthrodesis in the hand. J Hand Surg. 1986;11A:567–9.Google Scholar
  11. 11.
    Lister GD. Intraosseous wiring of the digital skeleton. J Hand Surg. 1978;3:427–35.Google Scholar
  12. 12.
    Pellegrini Jr VD, Burton RI. Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion? J Hand Surg. 1990;15A:194–209.Google Scholar
  13. 13.
    Scheker LR. A technique to facilitate drilling and passing intraosseous wiring in the hand. J Hand Surg Am. 1982;7(6): 629–30.PubMedGoogle Scholar
  14. 14.
    Uhl RL, Schneider LH. Tension band arthrodesis of finger joints: a retrospective review of 76 consecutive cases. J Hand Surg. 1992; 17A:518–22.Google Scholar
  15. 15.
    Vanik RK. The comparative strengths of internal fixation techniques. J Hand Surg Am. 1984;9(2):216–21.PubMedGoogle Scholar
  16. 16.
    Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am. 2003;28(5): 856–65.PubMedCrossRefGoogle Scholar
  17. 17.
    Takigawa S, Meletiou S, Sauerbier M, Cooney WP. Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand. J Hand Surg Am. 2004;29(5):785–95.PubMedCrossRefGoogle Scholar
  18. 18.
    Namdari S, Weiss AP. Anatomically neutral silicone small joint arthroplasty for osteoarthritis. J Hand Surg Am. 2009;34(2): 292–300.PubMedCrossRefGoogle Scholar
  19. 19.
    Branam BR, Tuttle HG, Stern PJ, Levin L. Resurfacing arthroplasty versus silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg Am. 2007;32(6):775–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Simmons B, Peters T. Subchondylar fossa reconstruction for malunion of fractures of the proximal phalanx in children. J Hand Surg. 1987;12A:1079–82.Google Scholar
  21. 21.
    Gross M, Gelberman R. Metacarpal rotational osteotomy. J Hand Surg. 1985;10A:105–8.Google Scholar
  22. 22.
    Jawa A, Zucchini M, Lauri G, Jupiter J. Modified step-cut osteotomy for metacarpal and phalangeal rotational deformity. J Hand Surg Am. 2009;34(2):335–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Pichora DR, Meyer R, Masear VR. Rotational step-cut osteotomy for treatment of metacarpal and phalangeal malunion. J Hand Surg. 1991;16A:551–5.Google Scholar
  24. 24.
    Lucas GL, Pfeiffer CM. Osteotomy of the metacarpals and phalanges stabilized by AO plates and screws. Ann Chir Main. 1989;8(1):30–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Teoh LC. Condylar advancement osteotomy for correcting condylar malunion of the finger. J Hand Surg Br. 2002;27(1):31–5.PubMedGoogle Scholar
  26. 26.
    Del Piñal F. Results of osteotomy, open reduction, and internal fixation for late-presenting malunited intra-articular fractures of the base of the middle phalanx. J Hand Surg Am. 2005;30(5):1039.e1–1039.e14.CrossRefGoogle Scholar
  27. 27.
    Harness NG, Chen A, Jupiter JB. Extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx. J Hand Surg Am. 2005;30(3):566–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Williams RM, Hastings II H, Kiefhaber TR. PIP fracture/dislocation treatment technique: use of a hemi-hamate resurfacing arthroplasty. Tech Hand Up Extrem Surg. 2002;6(4):185–92.PubMedCrossRefGoogle Scholar
  29. 29.
    Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am. 2003;28(5):856–65.PubMedCrossRefGoogle Scholar
  30. 30.
    Jupiter JB, Koniuch MP, Smith RJ. The management of delayed union and nonunion of the metacarpals and phalanges. J Hand Surg. 1985;10A:457–66.Google Scholar
  31. 31.
    Calkins MS, Burkhalter WE, Reyes F. Traumatic segmental bone defects in the upper extremity: treatment with exposed grafts of corticocancellous bone. J Bone Joint Surg. 1987;9A:19–27.Google Scholar
  32. 32.
    Saint-Cyr M, Miranda D, Gonzalez R, Gupta A. Immediate corticocancellous bone autografting in segmental bone defects of the hand. J Hand Surg Br. 2006;31(2):168–77.PubMedCrossRefGoogle Scholar
  33. 33.
    Freeland AE, Jabaley ME, Burkhalter WE, Chaves A. Delayed primary bone grafting in the hand and wrist after traumatic bone loss. J Hand Surg. 1984;9A:22–7.Google Scholar
  34. 34.
    Buchler U, Aiken AA. Arthrodesis of the proximal interphalangeal joint by solid bone grafting and plate fixation in extensive injuries to the dorsal aspect of the finger. J Hand Surg Am. 1988; 13A:589–94.CrossRefGoogle Scholar
  35. 35.
    Rinaldi E. Autografts in the treatment of osseus defects in the forearm and hand. J Hand Surg. 1987;12A:282–6.Google Scholar
  36. 36.
    Trumble TE, Freidlaender GE. Use of allogenic bone in hand injuries. Tech Orthop. 1986;1:79–83.CrossRefGoogle Scholar
  37. 37.
    Matev IE. The bone-lengthening method in hand reconstruction: twenty years’ experience. J Hand Surg. 1989;14A:376–8.Google Scholar
  38. 38.
    Finsen V, Russwurm H. Metacarpal lengthening after traumatic amputation of the thumb. J Bone Joint Surg Br. 1996;78(1):133–6.PubMedGoogle Scholar
  39. 39.
    Melikyan EY, Beg MS, Woodbridge S, Burke FD. The functional results of ray amputation. Hand Surg. 2003;8(1):47–51.PubMedCrossRefGoogle Scholar
  40. 40.
    Iselin F, Peze W. Ray centralization without bone fixation for amputation of the middle finger. J Hand Surg. 1988;13B:97–9.Google Scholar
  41. 41.
    Segalman KA. Lateral approach to proximal interphalangeal joint implant arthroplasty. J Hand Surg Am. 2007;32(6):905–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Bickel KD. The dorsal approach to silicone implant arthroplasty of the proximal interphalangeal joint. J Hand Surg Am. 2007;32(6):909–13.PubMedCrossRefGoogle Scholar
  43. 43.
    Duncan SF, Merritt MV, Kakinoki R. The volar approach to proximal interphalangeal joint arthroplasty. Tech Hand Up Extrem Surg. 2009;13(1):47–53.PubMedCrossRefGoogle Scholar
  44. 44.
    del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg. 2007;60(7):776–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Boulas HJ. Autograft replacement of small joint defects in the hand. Clin Orthop Relat Res. 1996;327:63–71.PubMedCrossRefGoogle Scholar
  46. 46.
    Hanel DP, Lederman ES. Index transposition after long finger ray resection. J Hand Surg. 1993;18A:271–7.Google Scholar
  47. 47.
    Plasschaert MJ, Hage JJ. A web-saving skin incision for amputation of the third or fourth ray of the hand. J Hand Surg Br. 1988;13(3):340–1.PubMedCrossRefGoogle Scholar
  48. 48.
    Steichen JB, Idler RS. Results of central ray resection without bony transposition. J Hand Surg. 1986;I1A:466–74.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Section of Hand and Micro Surgery, Department of Orthopaedics and Sports Medicine, Harborview Medical CenterUniversity of WashingtonSeattleUSA

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