Comparison of Lag Versus Nonlag Screw Fixation for Long Oblique Proximal Phalanx Fractures: A Biomechanical Study

Crushing Consequences: A Case Report on the Rehabilitation of a Middle Phalangeal Fracture in an Industrial Incident

Hand injuries, particularly fractures involving the phalanges and metacarpals, are common occurrences in various settings, including industrial environments. Prompt and effective management of these injuries is crucial to minimize long-term disability and facilitate return to work. This case report focuses on the rehabilitation of a middle phalangeal fracture in an industrial worker following Kirschner wire (K-wire) fixation. The patient, a 24-year-old male, sustained the injury while operating an electric stamping machine. Emergency surgery was performed to stabilize the fracture, and subsequent physiotherapy was initiated due to persistent difficulties in hand function. The rehabilitation protocol aimed to address pain, improve range of motion, and enhance grip strength through passive range of motion exercises, movement with mobilization techniques, blocking exercises, and grip strengthening exercises. Mulligan's mobilization with movement (MWM) concept was incorporated to facilitate rapid pain relief and movement restoration. Follow-up assessments after four weeks of rehabilitation revealed significant improvements in pain levels, range of motion, strength, and overall quality of life. The case underscores the importance of timely intervention and comprehensive rehabilitation strategies in managing traumatic hand injuries in industrial settings, aiming to optimize treatment outcomes and promote successful return to work.

Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures

PURPOSE

This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures.

METHODS

A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature.

RESULTS

Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort.

CONCLUSION

Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.