Preliminary Results: Factors Associated With Phalangeal Fractures
Ritsaart Frederik Westenberg, MD; Kamil Oflazoglu, MD; Bo J.W. Notermans, MD; Sezai Özkan, MD; Neal C Chen, MD; Kyle R. Eberlin, MD
Massachusetts General Hospital, Harvard Medical School, Boston, MA
Introduction There is variation of the reported incidence of nonunion in phalangeal fractures after surgical and non-surgical treatment. The factors related to non-union after finger fractures are unknown. This study tested the primary null hypothesis that there are no factors associated with nonunion of phalangeal fractures and no difference between proximal, mid and distal phalangeal fractures.
Methods We assessed 2019 patients with phalangeal finger fractures between January 2010 and January 2015. All phalangeal fractures were assessed for fracture location (finger, phalanx and anatomic location of the phalanx) and presence of nonunion. Fractures with a follow-up time of less than 4 months were excluded. Nonunion was defined as lack of callus formation or bony bridging after 4 months, fractures which had additional treatment after 4 months because of nonunion, and failed digital arthrodesis. Nonunion cases, were assessed for patient characteristics (age, sex, smoking, BMI, diabetes, osteoporosis), fracture location, joint-involvement, hand dominance, mechanism of injury, time to treatment, length of follow-up, comminution, open fracture, bone loss, and infection. All nonunion cases were matched with united fractures based on their fracture location to assess associations between our explanatory variables and nonunion.
Results Fifteen of 2019 patients developed a phalangeal nonunion. Within these 15 patients, 20 non-united fractures were found. The mean follow-up time was 13±9 months. Table 1 shows patient characteristics and table 2 the distribution of our explanatory variables within these nonunion cases.
Conclusion Most of the nonunion cases were open fractures (90%), comminuted (80%) or had bone loss (80%). Further analysis of the data in this study may lead to the understanding of factors associated with nonunion and present a rate of nonunion in proximal, mid and distal phalanges.
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