Risk Factors for Nonunion After Distal Phalangeal Fractures of the Hand

Abstract

Purpose: This study aimed to evaluate the risk factors for distal phalanx fracture nonunion.

Methods: We retrospectively reviewed all adult patients treated for distal phalanx fractures at our institution between January 2015 and December 2019 with a minimum one-year follow-up period for potential risk factors. The absence of consolidation signs on follow-up radiographs at least 12 months after trauma was defined as nonunion.

Results: This study included 124 patients with 143 fractures available for follow-up. Nonunion was diagnosed in 19 patients, 18 of whom initially presented with an open fracture. On the day of the injury, 17 patients with open fractures presented to the hospital. In 16 nonunion cases, the traumatic mechanism was a crush injury. All nonunions occurred in tuft fractures, and none required revision surgery at the follow-up visit.

Conclusions: Our findings suggest that tuft involvement in open fractures is the main risk factor for nonunion of distal phalangeal fractures. However, after a minimum of 1 year of follow-up, none of the tuft nonunions required revision surgery.

Type of study/level of evidence: Therapeutic IV.

Keywords: Distal phalangeal fractures; hand fractures; nonunion; risk factors.