gms | German Medical Science

Objective: Adhesion problems are common after plate fixation of finger phalanges and often lead to stiffness and reoperations with plate removal and tenolysis. Our aim of this pilot study was to study the effect of the adhesion barrier gel, DynaviscR on range of motion and postoperative pain. A clinically significant effect was set to 20° or less difference of active range of motion (AROM) in the PIP joint compared to the contralateral finger three months after surgery.

Materials and Methods: 10 consecutive patients were included, 7 men, mean age 44 (31-61) years. 1 ml of Dynavisc R was applied at surgery in two corrective osteotomies and eight mini-plate fixations of fractures of the proximal phalanx. Active mobilization was started 1-5 days postoperatively (baseline). AROM in all finger joints, grip strength and pain was measured at 2 weeks, 3 months and one year postoperatively. Pain was also reported at baseline on a Visual Analogue Scale (VAS) 0-100. Grip strength was measured with a Jamar dynamometer. Contralateral side was used as control.

Results: Median AROM in all three joints was 218° (mean 209°). A minor PIP extension lag was found in 9 patients, median 15° (mean 17°). Five of 10 patients reached the decided clinically significant level of difference in PIP joint AROM, median difference was 22° (range 5-85). Baseline pain at rest was median 7 mm and in motion 50 mm. Pain at rest at three months was 0 mm and pain in motion 9 mm. Mean grip strength at three months was 26,7 kg compared to 40,4 kg in the uninjured hand. One plate removal was performed at 5,5 months postoperatively.

Conclusions: The results of this small pilot study were not conclusive, but indicate that the barrier gel might contribute to better results and facilitate early mobilization after plate fixation of phalanges. Total AROM of 218° compared well with previous studies reporting 183°. Larger, randomized trials are required.