Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand

Abstract

Background: Optimized functional results are difficult to achieve following hand injuries. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of metacarpal and phalangeal fractures.

Materials and methods: Forty-five fractures of digits of hand in 31 patients were managed by surgical stabilization. Five fractures were fixed with closed reduction and percutaneous Kirschner wire fixation; 10 with external fixator; 26 with open reduction and Kirschner wire fixation; and four with open reduction and plate and screw or screw fixation.

Results: Final evaluation of the patients was done at the end of three months. It was based on total active range of motion for digital functional assessment as suggested by the American Society for surgery of hand. Overall results were excellent to good in 87%. Better total active range of motion (excellent grade) was observed in metacarpal fractures (47%) versus phalanx fractures (31%); closed fractures (57%) versus open fractures (27%); and single digit involvement (55%) versus multiple digits (29%). Excellent total active range of motion was observed with all four plate and screw/ screw fixation technique (100%) and closed reduction and percutaneous kirschner wire fixation (60%). Twenty-two complications were observed in 10 patients with finger stiffness being the most common.

Conclusion: Surgical stabilization of metacarpal and phalangeal fractures of hand seems to give good functional outcome. Closed fractures and fractures with single digit involvement have shown a better grade of total active range of motion.

Keywords: Metacarpal fractures; phalangeal fractures; surgical stabilization.

Figure 1

Preoperative radiographs showing open fractures of III^rd and IV^th metacarpal

Figure 2

Postoperative radiographs showing good alignment after fixation with two Kirschner wires

Figure 3

Radiographs after Kirschner wire removal showing union of fracture and good alignment

Figure 4

Clinical photographs showing excellent total active range of motion at follow-up of six months

Figure 5

Preoperative radiographs showing transverse fracture of 2nd metacarpal; and fracture neck of 3^rd and 4^th metacarpals

Figure 6

Postoperative radiographs showing good fixation with plate and screws of 2nd metacarpal fracture; and fixation with Kirschner wires for fracture neck of 3^rd and 4^th metacarpals.

Figure 7

Radiographs showing union of fractures after removal of Kirschner wires

Figure 8

Clinical photographs showing excellent hand function at follow up of six months.