Plate or Screw Fixation in Proximal Phalangeal Fractures: An Interim Analysis of the POSI-P1 Trial
In brief
Dorsal plating brought more major complications, with similar finger motion across methods
In this interim randomized trial of 101 adults with 107 fractures, total finger motion and other patient- and clinician-reported outcomes did not differ among dorsal plates, lateral plates, and intramedullary screws. Screw fixation took less time, while dorsal plating was significantly more likely to lead to a major complication; final trial results will clarify how the methods compare.
- Journal
- Hand (New York, N.Y.) (Q1)
- Published
- 1 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Brahman S Sivakumar, Luke W McCarron, Ray Jongs, David J Graham
- PMID
- 42968443
- DOI
- 10.1177/15589447261497442
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 3 November 2026): Randomized comparison informs fixation choices in hand fractures
Abstract
BACKGROUND: Phalangeal fractures are common, with no consensus on their ideal management. The aim of this interim analysis is to compare outcomes following dorsal plating, lateral plating or intramedullary screw fixation of displaced extra-articular proximal phalangeal fractures in an adult population. METHODS: A multicentre randomized controlled trial was conducted across 8 sites in Australia. Patients aged 18 years or older with closed extra-articular proximal phalangeal fractures who were able to undergo intervention within 14 days of injury were eligible for inclusion. Included patients were randomized to fixation via either dorsal plating, lateral plating or intramedullary screw stabilization. Patients were assessed at 6 weeks, 3 months, 6 months and 1 year. The primary outcome assessed was total active motion. Secondary outcomes included grip and lateral pinch strengths, patient-reported outcome measures, and both major and minor complications. RESULTS: A total of 101 patients with 107 fractured proximal phalanges were recruited, with treatment groups of 42 digits (41 patients) for dorsal plating, 32 digits (30 patients) undergoing lateral plating and 33 digits (30 patients) receiving intramedullary screws. No difference was noted in any parameter, bar length of surgery (favouring intramedullary screws) and major complications (favouring both intramedullary screws and lateral plating). CONCLUSIONS: This interim analysis finds no difference in total active motion or patient- and clinician-reported outcome measures between the 3 interventions. Both dorsal plating and lateral plating require more surgical time to perform the intervention. Dorsal plating is significantly more likely to result in a major complication. TYPE OF STUDY: Multicentre randomized controlled trialLevel of Evidence:Therapeutic IIb.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.