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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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What can you tell me about the kind of hardware they use to fix a broken thumb? I had a titanium plate and screws but when I went on-line I saw there is some newer stuff available now. Why didn't my surgeon use the new (better?) hardware?

The opposable thumb is still the one thing that distinguishes humans from other mammals. The anatomy is different from any of the other fingers. Without the thumb, we could not grip, pinch, grasp, or use the hand as we do now. Fine motor control for everyday actions like zipping a zipper, buttoning a button, or picking up any item would be severely impaired. That's why the treatment of thumb fractures and restoration of normal function is so important. Treatment goals are to stabilize the fracture so it can heal, restore normal alignment when there are deformities, care for soft tissue injuries, and return normal use of the thumb and hand. The type of fracture often dictates what type of treatment is required. Treatment is often based on which bone is affected including the location, type, and severity of the break. The present state of orthopedic treatment for this problem still rests with the surgeons' choice based on experience and preferences. This is because studies to provide best practice, evidence-based guidelines have not been developed yet. Surgical and fixation techniques (use of hardware such as wires, plates, and screws) are selected depending on the presence of soft tissue injuries (e.g. torn ligaments, damaged joint surface, muscle tears). These additional injuries complicate treatment decisions and may determine when open surgery is needed to complete repairs and/or reconstruction. Likewise, fractures that have displaced separated or twisted (rotated) may require more invasive surgical techniques in order to make the necessary repairs. The presence of multiple bone fragments or thumb dislocation (or other instability) can hinder successful return-of-function. Surgeons also make decisions based on known advantages and disadvantages of each type of suture (double row versus single row), fixation method, locking versus nonlocking plates, and hardware removal. Titanium (metal) plates and screws are still the standard choice for many thumb fractures. More surgeons are using bioabsorbable plates and screws as the materials continue to improve. With the newer biodegradable copolymer hardware, there is the advantage of not having a second surgery to remove the hardware. But this advantage must be weighed against the disadvantages of foreign body reactions and higher refracture rates reported with these newer products. Loss of strength and worse clinical results have also been noted with the newer biodegradable copolymer hardware. Some surgeons are sticking with the metal implants until hardware composition improves enough to eliminate these potential problems. There are probably specific reasons why your surgeon chose to treat you with the titanium materials. Next time you are in for a follow-up appointment, don't be afraid to ask what his or her thinking was on this. Patient interest is often appreciated by surgeons who like to educate others.


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