The Acute Management of Unstable Intra-Articular Fractures of the Base of the Middle Phalanx: A Systematic Review

Background: Within hand trauma, the management of unstable, intra-articular fractures of the base of the middle phalanx remains highly controversial. The objective of this research was to determine which operation gives the best outcome in the management of displaced, intra-articular fractures of the base of the middle phalanx causing instability of the proximal interphalangeal joint. Methods: A scoping study was performed to determine the evidence available and the terminology used. A Systematic Review was then performed along PRISMA guidelines. This Systematic Review looked specifically for papers available in English, published over the last ten years, with clinical data for at least five cases of acute unstable fractures of the base of the middle phalanx. There must be two years follow-up with less than 30% loss to follow-up. Results: There were no Systematic Reviews or Cochrane reviews. There were no randomized controlled trials and the best studies were simply cohort studies with level III or IV evidence. There was a paucity of high quality studies, with small, heterogeneous groups, short length of follow-up and high loss to follow up. Only seven papers met the Systematic Review criteria. Conclusions: General trends show excellent return of grip strength and good function despite some ongoing pain and stiffness. There were high complication rates for all techniques and the possible reasons for different outcomes are discussed.