Pin vs plate fixation for metacarpal fractures: a meta-analysis

Abstract

Background: The differences in the clinical and functional outcomes of closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screws have been systematically synthesized by one meta-analysis. With newer studies being published, an effort to update the earlier meta-analysis is necessary.

Methods: Comprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. Randomized controlled trials, quasi-experimental studies, prospective comparative non-randomized studies, and even studies reporting findings from retrospective chart review were eligible to be included. Statistical analysis was done using STATA version 13.0. GRADE assessment was done to assess the quality of pooled evidence.

Results: A total of 9 studies were included. The pooled estimates did not suggest any significant differences in the disabilities of the arm, shoulder, and hand (DASH) score [WMD - 0.77; 95% CI, - 3.55, 2.00; I² = 75.5%], range of movement (ROM) of the metacarpophalangeal joint (^o) [WMD 4.44; 95% CI, - 4.19, 13.07; I² = 86.0%], and grip strength [WMD - 4.63; 95% CI, - 14.52, 5.26; I² = 86.9%] among the two intervention modalities. No difference was seen in the risk of complications between the two interventions (RR 0.93; 95% CI, 0.57, 1.53; I² = 31.2%). For all the outcomes, the quality of pooled evidence was judged as low to very low.

Conclusion: No significant long-term differences were noted in the functional outcomes suggesting that both these techniques are comparable. The choice of modality should be made based on the skills and preference of the surgeon and availability of resources.

Keywords: Meta-analysis; Metacarpal fractures; Open reduction with internal fixation; Percutaneous pin fixation.

Fig. 1

Selection process of the studies included in the review

Fig. 2

Comparison of pooled DASH scores among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)

Fig. 3

Comparison of pooled DASH scores among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws) by sub-groups based on the mean age of participants and duration of post-operative follow-up

Fig. 4

Comparison of pooled range of movement (ROM) of the metacarpophalangeal joint (°) among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)

Fig. 5

Comparison of pooled range of movement (ROM) of the metacarpophalangeal joint (°) among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws) by sub-groups based on the mean age of participants and duration of post-operative follow-up

Fig. 6

Comparison of pooled grip strength (as percentage of the unaffected side) among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)

Fig. 7

Comparison of pooled grip strength (as percentage of the unaffected side) among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws) by sub-groups based on the mean age of participants and duration of post-operative follow-up

Fig. 8

Comparison of limb shortening (in mm) assessed by radiography among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)

Fig. 9

Comparison of limb shortening (in mm) assessed by radiography among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws) by sub-groups based on the mean age of participants and duration of post-operative follow-up

Fig. 10

Comparison of visual analogue scale (VAS) pain score among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)

Fig. 11

Comparison of complication rates among the two groups (i.e., pinning for metacarpal fractures compared to ORIF with plate and screws)