The Plate or Screw in Proximal Phalangeal Fractures [POSI-P1]

The proximal phalanges are the first bone in each finger. When people break their proximal phalanges, the break may need to be fixed surgically. The break may be fixed with a plate on the back of the bone [where the overlying tendon is cut and later repaired]; a plate on the side of the bone; or a screw through the middle of the bone. We want to find out which option gives the best result, in terms of finger movement and overall. The main finding of this study will tell us which surgical option gives the most finger movement, which may allow better use of that finger and hand. The other findings will look at which surgical option gives the best overall result from a patient’s point of view; which option allows the patient to regain better pinching and gripping power; and which option has more frequent risks. This knowledge, and identification of the balance of risks and benefits for each option, will help more patients receive the treatment that will give them the best chance of obtaining good function in that finger and hand, as well as help surgeons guide patients in making informed health decisions. Regaining function will be important not only for the patient [who will be able to return to work or their daily activities more rapidly], but also the health system and community as a whole. Although a plate on the back of the bone has been commonly used to fix breaks, there are concerns that cutting the tendon and putting a plate underneath will cause scarring, diminishing finger motion and patient satisfaction. This study will compare a plate on the back of the proximal phalanx to two other options: a plate on the side of the bone and a screw through the middle of the bone. There are no studies that have previously performed such a comparison. The objective of this study is to determine which of the three options provides the best balance of risk and benefit for the patient. The main finding assessed will be finger movement, which may allow better use of that finger and hand. Other findings will look at the overall result for the patient; pinching and gripping power; and the risks of each operation.