Management of extra-articular shaft fractures of the non-thumb metacarpals: plate-screw fixation versus K-wire fixation

Abstract

Metacarpal fractures are common injuries and comprise nearly 36% to 42% of all fractures in the hand. The majority of these can be managed non-surgically. Operative fixation when needed, can be done by a variety of techniques. In this study, we have compared the outcomes of two techniques, plate-screw fixation and K-wire fixation. We have conducted a prospective, non-randomized, comparative study of patients who presented with extra-articular metacarpal shaft fractures of non-thumb metacarpals over a period of 18 months. 30 patients were enrolled according to the inclusion criteria and were alternately allotted to the plate-screw group and the K-wire group. At admission, patient demographics, clinical features, number of fractures, and fracture patterns were recorded, and radiographs were taken. In the plate-screw group, low-profile plates and screws were used, and in the K-wire group, 1 or 2 K-wires were used for fixation after fracture reduction. Hand mobilization exercises were started within one week in the plate-screw group, while in the K-wire group full mobilization was allowed at 4 weeks post-surgery. The Disabilities of Arm, Shoulder and Hand (DASH) score was calculated and compared between the two groups at 6 months and 12 months after surgery. The mean 6-month DASH score in the plate-screw group was 6.3287±2.2453, while it was 17.1627±6.2103 in the K-wire group (p value <0.001). At the end of 1-year follow-up, the mean DASH score in the plate-screw group was 5.1080±1.6637, and in the K-wire group, it was 5.1073±1.9392 (p value =0.848). In conclusion, extra-articular metacarpal shaft fractures of the non-thumb metacarpals treated by plate-screw fixation had significantly better DASH scores and hence better functional outcomes at the end of 6 months. However, at the end of 1 year, the DASH scores in both the groups were almost similar, suggesting similar functional outcomes in the long term.

Keywords: Metacarpal bones; articular; bone; bone plates; bone screws; fractures; range of motion.

Figure 1

Fractures of the shafts of metacarpals 2, 3 and 4 in an 18-year-old female patient (patient 1 in the plate-screw group). A: Anteroposterior view radiograph; B: Lateral view radiograph.

Figure 2

Intra-operative picture of plate-screw fixation.

Figure 3

Post-operative picture following plate-screw fixation. A: Anteroposterior view radiograph, note the cerclage in the 2^nd metacarpal. B: Oblique view radiograph.

Figure 4

Picture at 1-year post-surgery. A: Anteroposterior view radiograph; B: Oblique view radiograph.

Figure 5

Fractures of the shafts of metacarpals 4 and 5 in an 18-year-old male patient (patient 2 in the plate-screw group). A: Anteroposterior view radiograph; B: Lateral view radiograph.

Figure 6

Post-operative picture following plate-screw fixation. A: Anteroposterior view radiograph; B: Oblique view radiograph.

Figure 7

Picture at 1-year post-surgery. A: Anteroposterior view radiograph; B: Oblique view radiograph.