Optimising outcomes following proximal phalangeal fracture fixation

Abstract

The aim of the five studies reported in this thesis is to explore factors that are associated with, and efficacy of intervention for, proximal phalangeal fracture following surgical fixation. Study 1 examined whether baseline characteristics are predictive of total active range of motion six weeks following surgical repair of proximal phalangeal fracture. Studies 2 and 3 compared efficacy of two exercise intervention protocols on short and medium-term outcome following open reduction and internal fixation (ORIF) of proximal phalangeal fracture. Study 4 investigated the pattern of recovery following proximal phalangeal ORIF and whether this recovery is related to adherence to rehabilitation. Study 5 examined whether baseline characteristics predict outcome twelve weeks after ORIF of proximal phalangeal fracture. Study 1 found that earlier commencement of active finger exercises following fixation of proximal phalangeal fracture independently predicts greater range of motion six weeks post-operatively, and should be encouraged. Studies 2 and 3 found that within the broader setting of intensive rehabilitation with early commencement of active finger exercise and close monitoring, type of exercise performed made no difference to outcome in either the short or medium-term following proximal phalangeal ORIF. Study 4 found that prior to commencement of rehabilitation, range of motion was poor, and few were able to return to their full employment duties, but pain on average was mild. Most of the recovery following fixation occurred in the first six weeks, with progressively smaller gains beyond that time, with excellent recovery achieved by six months. Study 5 found an association between resting pain in the first week following proximal phalangeal ORIF, and resting pain, pain with activity and hand use twelve weeks post-operatively. These findings suggest clinicians should routinely screen for baseline resting pain, and target individuals reporting high levels.