Indian Journal of Orthopaedics Surgery


Evaluation of different modalities of osteosynthesis in metacarpal fractures in adults


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Author Details: Arpit Tiwari, Piyush Rajesh, RS Saluja

Volume : 3

Issue : 1

Online ISSN : 2395-1362

Print ISSN : 2395-1354

Article First Page : 6

Article End Page : 11


Abstract

Background and Objectives: 107 Metacarpal fractures in 81 patients were treated in Index Hospital, Indore from January 2015 to June 2016, with the objective of studying clinically and radiologically, the incidence, mechanism of injury, types of fracture and various treatment aspects. Results were compared to assess the efficacy of different treatment modalities and compare their functional outcomes of the metacarpal fractures of hand.
Materials and Methods: 107 metacarpal fractures in 81 patients were enrolled from January 2015 to June 2016. The treatment modalities were broadly categorized into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment. Group A included 38 fractures treated with cock-up splint (n=33) and thumb spica(n=5), while 69 fractures were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=52), OR and IF with miniplate and screws (n=17). Total active range of motion as Suggested by the American society for surgery of hand and Gingrass’s criteria were used for functional assessment and to assess the efficacy of conservative and surgical modalities for metacarpal fractures of the hand.
Results: Final evaluation of the patients done at the end of three months. The excellent to good results seen in Group A and B were 76.3% and 89.9%, respectively. Six Complications were seen in Group A, which included four cases with malunion and two cases with stiffness. Four complications were seen in Group B, which included two cases with stiffness and one each of pin tract infection and operative wound infection.
Conclusion: Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery. Surgical modalities have distinct advantage of stable fixation but with added risk of stiffness. Both conservative and Surgical modalities have good efficacy when used judiciously, Single fractures have shown better grade of total active range of motion compared to multiple fractures.
Treatment objective may be compromised if post-treatment physiotherapy and rehabilitation using systemic protocol is not followed.

Keywords:
Metacarpal fracture, Hand, Closed reduction, Open reduction, Conservative and Surgical treatment.