Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Controlled active exercise after open reduction and internal fixation of hand fractures

  • Jun, Dongkeun (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Bae, Jaehyun (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Shin, Donghyeok (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Choi, Hyungon (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Kim, Jeenam (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Lee, Myungchul (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine)
  • Received : 2020.08.31
  • Accepted : 2020.11.13
  • Published : 2021.01.15
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Abstract

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes. Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed. Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up. Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

Keywords

References

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