Title: A Study on Functional Outcome of Various Modalities of Internal Fixation of Metacarpal and Phalangeal Fractures of Hand - A Prospective Study
Authors: V. James Sundar Singh, Prof. Dr A.Senthilnathan, Dr R.Prabhakar, Dr P.S.Balamurugavel, Dr M. Viswanathan, Dr M.Harrivishnu, Dr V.Manooj Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.111
Background: Fractures of the bones of the hand are among the commonest fractures in humans but their management varies widely in different regions of the world. The variability is due to many reasons including availability of resources, social factors, geographic constraints, surgeon’s preference and experience and local practice patterns. Hand fractures constitute 14 to 28% of all visits to hospital following trauma by various means. These fractures are often neglected or treated as minor injury and results in major disability. Methods: This study included 40 patients with unstable metacarpal and phalangeal fractures which were internally fixed by various modalities at Rajah Muthiah Medical College. The outcome was analysed with special emphasis on active movement of fingers at metacarpophalangeal and interphalangeal joints. Results: We assessed the functional outcome with American Society for Surgery of the Hand (ASSH) score and Total Active Flexion (TAF) score.100% union achieved in all cases with average period of union as 7.2 weeks, functional outcome was excellent in 80%, good in 10%, fair in 5% and poor in 5%. 8 persons developed complications of which 4 had infection and the other 4 had joint stiffness. Conclusion: Various modalities of internal fixation is a good option for treating unstable metacarpal and phalangeal fractures as it allows early mobilisation and good functional results provided detailed clinical and radiological assessment of the fracture, careful pre operative planning, meticulous dissection, precision in surgical technique and choosing the correct implant are strictly followed. 1. Gupta R, Singh R, Siwach RC, Sangwan SS. Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand. Indian J Orthop 2007;41(3);224-29 2. deJonge JJ, Kingma j, van der Lei B. Fractures of the metacarpals. A retrospective analysis of incidence and etiology and a review of the English- language literature. Injury 1994;25:365-9 3. Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in managing fractures of metacarpal and phalanges. Indian J PlastSurg 2011; 44: 203-11. 4. Barton NJ. Fractures and joint injuries of hand. In : Wilson JN editor. Watson – Jones fractures and joints injures. 6thedn Vo. II Churchill Livingstone Pvt. Ltd, New Delhi 1996:p.739-88. 5. Brenwald J (1987) Bone healing in the hand. ClinOrthopRelat Res 214:7-10 6. Stern PJ (1999) Fractures of the metacarpals and phalanges. In: Green DP (ed) Operative hand surgery, vol 1. Churchill Livingstone, New York, pp 711–77 7. Stern PJ: Management of fractures of the hand over the last 25 years. J Hand Surg [Am] 2000; 25:817-823. 8. AswiniSoni, AnmolGulati, J.L Basi: outcome of closed ipsilateral metacarpal fractures treated with minifragment plates and screws: a prospective study: J orthopaedTraumatol (2012) 13: 29-33 9. Barton N (1989) Conservative treatment of articular fractures in the hand. J Hand Surg Am 14:386–390 10. Wright TA (1968) Early mobilization in fractures of the metacarpals and phalanges. Can J Surg 11:491–498 11. Amadio PC (1991) Fractures of the hand and the wrist. In: Jupiter JB (ed) Flynn’s hand surgery. Williams & Wilkins, Baltimore, pp 122–185 12. James JIP (1962) Fractures of the proximal and middle phalanges of the fingers. ActaOrthopScand 32:401–412 13. Parsons SW, Fitzgerald JA, Shearer JR (1992) External fixation of unstable metacarpal and phalangeal fractures. J Hand Surg Br 17(2):151–155 14. Shehadi SI (1991) External fixation of metacarpal and phalangeal fractures. J Hand Surg Am 16(3):544–550 15. Schuind F, Donkerwolcke M, Burny F (1991) External minifixation for treatment of closed fractures of the metacarpal bones.JOrthop Trauma 5(2):146–152 16. Pritsch M, Engel J, Farin I (1981) Manipulation and external fixation of metacarpal fractures. J Bone Joint Surg Am 63(8):1289–1291 17. Buchler U (1994) The small AO external fixator in hand surgery.Injury 25 (Suppl 4):S-D55-63 18. Gonzalez MH, Igram CM, Hall RF (1995) Flexible intramedullary nailing for metacarpal fractures. J Hand Surg 20:382-387 19. Orbay JL, Indriago I, Gonzalez E et al (2002) Percutaneous fixation of metacarpal fractures. Op Tech Plast Reconstruct Surg 9:138–142 20. Gonzalez MH, Hall RF Jr (1996) Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand.ClinOrthopRelat Res 327:47–54 21. Itadera E, Hiwatari R, Moriya H et al (2008) Closed intramedullary fixation for metacarpal fractures using J-shaped nail. Hand Surg 13(3):139–145 22. Chen SH, Wei FC, Chen HC et al (1994) Miniature plates and screws in acute complex hand injury. J Trauma 37:237–242 23. Ford DJ, el-Hadidi S, Lunn PG et al (1987) Fractures of the metacarpals: treatment by A. O. screw and plate fixation. J Hand Surg Br 12:34–37 24. Dabezies EJ, Schutte JP (1986) Fixation of metacarpal and phalangeal fractures with miniature plates and screws. J Hand Surg Am 11:283–288 25. Bu¨chler U, Fischer T (1987) Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries. ClinOrthopRelat Res 214:53–58 26. Diwaker HN, Stothard J (1986) The role of internal fixation in closed fractures of the proximal phalanges and metacarpals in adults. J Hand Surg Br 11:103–108 27. Hastings H 2nd, Carroll C 4th (1988) Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints. Hand Clin 4:503–527 28. Melone CP Jr (1986) Rigid fixation of phalangeal and metacarpal fractures. OrthopClin North Am 17:421–435 29. Stern PJ, Wieser MJ, Reilly DG (1987) Complications of plate fixation in the hand skeleton. ClinOrthopRelat Res 214:59–65 30. Thakore HK (1986) Osteosynthesis for the unstable fracture of the hand. J Hand Surg Br 11:417–421 31. Trevisan C, Morganti A, Casiraghi A et al (2004) Low severity metacarpal and phalangeal fractures treated with miniature platesand screws. Arch Orthop Trauma Surg 124:675–680 32. Souer JS, Mudgal CS (2008) Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand SurgEur 33(6):740–744Abstract
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