Complications and range of motion following plate fixation of metacarpal and phalangeal fractures

Eighty-two patients with 105 metacarpal and/or phalangeal fractures stabilized with plates were retrospectively reviewed to assess complications and outcomes. Despite stable fixation and early mobilization, major complications were encounterec in 36% of fractures, especially with phalangeal and open fractures. Complications included stiffness, nonunion, plate prominence, infection, and tendon rupture. Forty-eight of 63 (76%) metacarpal fractures and 44 of 66 (67%) closed fractures had a final range of motion greater than 220 degrees; however, only 4 of 37 (11%) phalangeal fractues and 8 of 34 (24%) open fractures achieved this outcome. Despite technical advances in plate design and instrumentation, including lower-profile titanium plates, complications occur commonly with metacarpal and phalangeal fractures, leading to a high incidence of unsatisfactory results. We do not condemn plate fixation, and attribute many of our unsatisfactory results to the frequent use of plates in open and phalangeal fractures. Copyright (C) 1998 by the American Society for Surgery of the Hand.