Plate fixation of phalanx fractures is associated with multiple potential complications. These include stiffness, malunion, nonunion, infection, and tendon rupture.

Stiffness is the most common complication and is associated with complex fracture patterns requiring extensive soft tissue mobilization for fixation, and the failure to begin early postoperative motion. With certain fracture patterns, some amount of residual stiffness is inevitable, but this can be minimized by rigid fixation and early motion protocols.

Malunion becomes significant when it interferes with hand function. The most common deformity is rotational, as this is the most difficult to judge clinically without being able to take the digit through a full range of motion. If the resulting rotational or angular malunion is sufficient to hinder hand function, osteotomy after fracture healing can be performed secondarily.

Nonunion is associated with highly comminuted fractures resulting in bone loss, crush injuries, and open fractures. Nonunions can be treated effectively in most cases with internal fixation and bone graft.

Infection may be classified as superficial and deep. Superficial infections may be successfully treated initially with oral antibiotics and local wound care. Deep infection must be addressed with aggressive debridement and irrigation and intravenous antibiotics. Occasionally, removal of the implant may be required and the digit can be stabilized temporarily with pins or a small external fixator.

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