Distraction Plating for Intra-articular Proximal Phalanx Base Fractures on Middle Finger Reconstruction: A Case Report

Abstract

Phalanx fractures are among the most frequently encountered hand injuries, with fractures at the base of the proximal phalanx presenting unique management challenges due to their diverse presentations.We present a case of a 47year-old male with a complex fracture at the base of the proximal phalanx following a motorcycle accident.Radiology revealed severe comminution with apex volar angulation.Treatment involved open reduction and internal fixation with a miniplate using the distraction plating method; the hardware was removed at six weeks.Physical therapy was then initiated, and after one year, the patient achieved an excellent range of motion post-operatively (metacarpophalangeal joint of 45 -90°, proximal interphalangeal joint and distal interphalangeal joint were 0 -90°) comparable to pre-injury function.Radiographs showed union of the fracture and proper alignment.The successful application of distraction plating in complex comminuted distal radius fractures inspires further research and application in other challenging fractures.Distraction plating can effectively maintain proper fracture alignment while minimising strain on surrounding soft tissues.This supports bone healing and allows good radiological and functional outcomes.The favourable outcome in this case supports the use of distraction plating in situations where traditional fixation methods, such as Kirschner wire fixation, may be insufficient.Distraction plating may be an alternative to Kirschner wire fixation to maintain the proper alignment and avoid the risk of pin-track infections, and allow an early return to daily activities.The successful application of distraction plating in complex comminuted distal radius fractures has inspired further research and its application in other challenging fractures.Distraction plating can effectively maintain proper fracture alignment while minimising strain on surrounding soft tissues, thereby supporting bone healing and enabling favourable radiological and functional outcomes.Distraction plating may serve as a viable alternative to Kirschner wire fixation by maintaining proper alignment, reducing the risk of pintrack infections, and allowing an earlier return to daily activities.

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