Re-operation for tendon adhesions following open reduction and internal fixation of metacarpal fractures

Background: Among various fixation methods for metacarpal fractures, plate osteosynthesis is the most rigid and allows early rehabilitation leading to early return to work. Many authors have reported high complication rates and most of them were because of thick plate. The aim of this study was to report early results of plate osteosynthesis of metacarpal fractures with low profile miniplate. Methods: This was a hospital based prospective study. Unstable and irreducible fractures were managed by open reduction and internal fixation with low profile miniplate and were followed up for 6 months. The functional outcome after fracture treatment was assessed by ability to perform acts of daily life and calculating American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. Results: There were 16 patients with 17 metacarpal fractures, 87.5% were male with mean age of 31.50±9.02 years. Fourteen (87.5%) patients could perform their activities of daily living at four weeks. The mean Total Active Flexion was 261.76±24.87 at final follow up. Fourteen (87.5%) patients had excellent, one (6.25%) good and one (6.25%) poor out come at the end of 6 months. Conclusion: Low severity metacarpal fractures can be treated successfully by open reduction internal fixation with low-profile miniplate, allowing early and safe mobilization. Key words: low-profile plate, metacarpal fractures, plate osteosynthesis DOI: 10.3126/jnhrc.v7i1.2274 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 19-24

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Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.6846 ◽

2021 ◽

Vol 59 (239) ◽

Author(s):

Sagar Panthi ◽

Rishiswor Shrestha ◽

Jigyasu Pradhan ◽

Bikash Neupane ◽

Siddhartha Khanal ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Plate Fixation ◽

Care Center ◽

Tertiary Care ◽

Hand Injuries ◽

Tertiary Care Center ◽

Metacarpal Fracture ◽

Metacarpal Fractures ◽

Mini Plate

Introduction: Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center. Methods: This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis. Results: Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient. Conclusions: Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.

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Open Reduction and Internal Fixation Using Plate and Screws Versus Percutaneous Kirschner Wires Fixation for Second and Third Metacarpal Bones Fractures: A Meta-analysis

QJM ◽

10.1093/qjmed/hcab105.008 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Karim Samir Masoud ◽

Ahmad Fathi El Sherif ◽

Raghda Elsayed Tallal ◽

Mahmoud Mahrous Mohamed Waly

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Meta Analysis ◽

Surgical Techniques ◽

Functional Results ◽

Kirschner Wires ◽

Metacarpal Fractures ◽

Metacarpal Bones ◽

Surgical Fixation ◽

Type Of Fracture

Abstract Background Metacarpal fractures are among the most common fractures of the skeletal system and account for 36 % of hand and wrist fractures. Aim of the Work To determine the functional outcome and postoperative complications for both these surgical techniques in the treatment of second and third metacarpal bones fractures. Patients and Methods The systematic review was restricted to clinical studies of both these surgical techniques in the treatment of closed second and third metacarpal fractures. We reviewed studies that include management of metacarpal fractures with open reduction and internal fixation using plate and screws versus percutaneous crossed Kirschner wires fixation. Results No specification was made about the type of fracture, other than shaft fractures located in the second and the third metacarpal. All fractures were operated because of instability, angulations’ or rotational deformity. No comparison can therefore be made between fracture type (i.e. spiral, oblique) and functional results. As all studies reported identical indication for surgical fixation a comparison between type of fixation and functional result can be made. Conclusion Based on the reported results there is no evidence to suggest one fixation technique over another. The reported complications however for ORIF and K-wire fixation in the treatment of metacarpal fractures are unmistakably different for the two types of fixation.

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Controlled active exercise after open reduction and internal fixation of hand fractures

Archives of Plastic Surgery ◽

10.5999/aps.2020.01739 ◽

2021 ◽

Vol 48 (1) ◽

pp. 98-106

Author(s):

Dongkeun Jun ◽

Jaehyun Bae ◽

Donghyeok Shin ◽

Hyungon Choi ◽

Jeenam Kim ◽

...

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Open Reduction ◽

Axial Loading ◽

Early Postoperative Period ◽

Radiographic Images ◽

Metacarpal Fractures ◽

Hand Fractures ◽

Metacarpal Bones ◽

Functional Exercise

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes.Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed.Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up.Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

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Fractures of metacarpal bone: evaluation of functional outcome of open reduction and internal fixation with mini locking plate: a hospital based study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191795 ◽

2019 ◽

Vol 5 (3) ◽

pp. 519

Author(s):

Arumugam A. Kandasamy ◽

Mozammil Pheroz ◽

Arvind Kumar ◽

L. G. Krishna ◽

Ankit Jain ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Locking Plate ◽

Delayed Union ◽

Rigid Fixation ◽

Functional Evaluation ◽

Metacarpal Fractures ◽

Surgical Methods ◽

Metacarpal Bones

Background: Metacarpal bones fracture is very common. Management of metacarpal fractures varies from conservative to percutaneous pinning to various surgical methods. We endeavour to evaluate the functional outcome of metacarpal fractures in patients managed with open reduction and internal fixation with mini locking plate.Methods: A total of 32 patients with extra-articular metacarpal bones fracture were recruited for the study. After open reduction the fractures were fixed with the mini locking plate, postoperative day 3, plaster removed and active and passive exercises started. The Michigan hand score was used for functional evaluation, grip strength, visual analogue scale score, range of motion evaluated at follow up till six months.Results: All the 32 patients achieved union, 31 had full union at 6 weeks whereas 1 patient has delayed union. The Michigan hand outcome questionnaire score of 97.5 % at 6 months in all 32 patients. A total of 5 out of 32 patients had complications, the most common being finger stiffness followed by superficial infection and delayed union.Conclusions: We concluded that metacarpal plating with mini locking plate is a good option to achieve and maintain a rigid fixation and this method produces a better outcome in unstable fractures of metacarpal bones.

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Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures

Hand ◽

10.1177/15589447211003181 ◽

2021 ◽

pp. 155894472110031

Author(s):

Scott T. Allen ◽

Olivia J. Wang ◽

Lauren O. Erickson ◽

Christina M. Ward

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Plate Fixation ◽

Open Reduction Internal Fixation ◽

Fracture Pattern ◽

Patient Age ◽

Metacarpal Fractures ◽

Lag Screw ◽

Loss Of Reduction ◽

With Screws

Background This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. Methods We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. Results Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. Conclusions We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.

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