Volar plate fixation in the proximal third of the proximal phalanx fracture

Phalanx fractures are common hand fractures. Dorsal plate fixation is widely used to stabilize these fractures. However, this method has been observed to have a high rate of complications, such as extensor tendon adhesion and stiffness in the adjacent finger joints. This study aims to present a novel fixation method, applying volar plate fixation for proximal third phalanx fractures. Since the distance from the volar flexor tendons to the volar cortex of phalangeal bone is greater than from the extensor tendon to the dorsal cortex of phalangeal bone (as proven by hand MRI), there is relatively ample space for volar plate insertion, potentially leading to fewer complications.

A case series of nine patients is presented in this study. All nine fingers underwent volar plate fixation for proximal third proximal phalanx fractures and received local anesthesia. The stability of fracture fixation and the ideal plate position were examined via active range of motion under C-arm fluoroscopy intraoperatively. Rehabilitation for all patients started the day after surgery. The follow-up period of all patients extended for a minimum of one year, with X-rays taken at 1, 3, 6, and 12 months postoperatively.

All patients achieved satisfactory result in bone union and full active range of motion (ROM) in the finger joint. No major complications were reported, except for one case of delayed wound healing, which recovered well after dedicated wound care. Four patients underwent plate removal later, and intraoperative finding revealed a well-formed synovial membrane covering the plate, which was considered a barrier preventing flexor tendon attrition.

Our study indicates that volar plate fixation yields good functional outcomes, particularly in achieving full active range of motion without causing complications.

Keywords: fracture, phalanx, stiffness, plate