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 encountered 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 fractures 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.