Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand

  • Dr. D. S. Chaurasia Consultant, Orthopaedician, Dev Sudha Nursing Home Tikamgarh, India
  • Dr. Nirnay Pandey PGMO cum Senior Resident, Department of Orthopaedics, GMC Chhindwara, MP, India
DOI: https://doi.org/10.17511/ijoso.2019.i04.07
Keywords: Conservative method, Metacarpal fractures, Operative methods, Phalangeal fractures, Surgical stabilization

Abstract

Background: Fracture and dislocation of hand most frequently encounter in orthopaedics injuries fracture of phalanges and metacarpal are approximately 10% of all fracture of skeleton system phalangeal fracture comprise 46% of hand fractures, metacarpal fractures 38% and fifth metacarpal fracture 9.7%, distal phalangeal fractures are most commonly encounter fracture of the hand. The annual incidence of phalangeal fracture in hand is 1% in normal population. And these injuries account for between. 2% and 3% of all patient visiting in accident and emergency unit thumb and middle finger are most frequently injured because they extend most distally during work activity.

Aim & Objectives: To evaluate the structural and functional outcomes and the results of operative and conservative management of metacarpal and phalangeal fractures of hand.

Methods: The present study comprises of 62 patients of closed fractures of metacarpal and phalanx treated in the Department of Orthopaedic Surgery, Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital Rewa (M.P.) in a span of two years. Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand was done.

Results: We achieved 24 (85.7%) excellent and good results in conservative method for metacarpal fractures and 10 (83.33%) operative methods. In Phalangeal fractures 09 (90.0%) excellent and good results were achieved in conservative method and 10 (83.34%) in operative methods. Excellent and good grip strength was noted in 53 (85.33%) cases. Single digit involvement had better TAM then multiple digits involvement. Poor results were noted in metacarpal fractures in 04 (14%) in conservative series and 02 (16.0%) in operative series. Poor results were seen in phalangeal fractures in 01 (10%) in conservative series and 02 (16.66%) in operative series. Most common complication was finger stiffness in conservative method and pin site infection in operative methods.

Conclusion: Both conservative and operative methods (surgical stabilization) for metacarpal and phalangeal fractures of hand gave good functional outcomes, depending on the fracture pattern for treatment option, single digit involvement are important determinants to achieve a better grade of total active range of motion.

Downloads

Download data is not yet available.

References

1. Gupta R, Singh R, Siwach RC, Sangwan SS, Magu NK, Diwan R. Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand. Ind J Orthopaed. 2007; 41(3):224. doi: 10.4103/0019-5413. 33687

2. Duncan RW, Freeland AE, Jabaley ME, Meydrech EF. Open hand fractures: an analysis of the recovery of active motion and of complications. J Hand Surg Am. 1993; 18(3): 387-394. doi:10.1016/0363-5023(93) 90080-M

3. Trevisan C, Morganti A, Casiraghi A, Marinoni EC. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg. 2004;124(10):675-680.Epub 2004 Oct 28. doi: 10.1007/s00402-004-0745-7

4. Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y. Operative treatment of metacarpal and phalangeal fractures in athletes: early return to play. J Orthop Sci. 2014; 19(5): 729-736. doi: 10.1007/s00776-0140584-5. Epub 2014 Jun 10.

5. Tavassoli J, Ruland RT, Hogan CJ, Cannon DL. Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments. J Bone Joint Surg Am. 2005; 87(10): 2196-2201. doi:10.2106/JBJS. D.03038

6. Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. 2006;22(3):287-295.doi:10. 1016 /j. hcl. 2006.02.018

7. Horton TC, Hatton M, Davis TR. A prospective randomized controlled study of fixation of long oblique and spiral shaft fractures of the proximal phalanx: closed reduction and percutaneous Kirschner wiring versus open reduction and lag screw fixation. J Hand Surg Br. 2003;28(1):5-9. doi: https://doi.org/10. 1054/ jhsb. 2002.0807

8. Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000;8(2):111-121.

9. Omokawa S, Fujitani R, Dohi Y, Okawa T, Yajima H. Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system. J Hand Surg Am. 2008;33 (6):857-863. doi: 10.1016/j.jhsa.2008.01.040.

10. Shimizu T, Omokawa S, Akahane M, Murata K, Nakano K, Kawamura K, et al. Predictors of the postoperative range of finger motion for comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate. Injury. 2012;43(6):940-945. doi: 10. 1016/j. injury. 2012. 02.011. Epub 2012 Mar 28.

11. Ozer K, Gillani S, Williams A, Peterson SL, Morgan S. Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures. J Hand Surg Am. 2008;33(10):1724-1731. doi: 10.1016/j.jhsa.2008.07.011.

12. Orbay JL, Touhami A. The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails. Hand Clin. 2006; 22(3):279-286. doi:10.1016/j.hcl. 2006.02. 017

13.Gonzalez MH, Igram CM, Hall RF Jr. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am. 1995;20(3):382-387. doi:10.1016/S0363-5023 (05) 80091-7

14. Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary Kwires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br. 2006;31(1):61-65. Epub 2005 Aug 31. doi:10.1016/j.jhsb.2005.06.022

15. Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br. 1999;24(1):76-79.

16. Westbrook AP, Davis TR, Armstrong D, Burke FD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol. 2008; 33(6):732-739. doi: 10.1177/1753 193408092497. Epub 2008 Oct 20.

17. Strub B, Schindele S, Sonderegger J, Sproedt J, von Campe A, Gruenert JG. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur Vol. 2010;35(9):725-729. doi: 10.1177/ 1753193410377845. Epub 2010 Jul 21.

18.Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res. 2006;445:133-145. doi:10.1097/01. blo.000 0205888.04200.c5
CITATION
DOI: 10.17511/ijoso.2019.i04.07
Published: 2019-10-31
How to Cite
Chaurasia, D. S., & Pandey, N. (2019). Evaluation of outcomes after management of metacarpal and phalangeal fractures of hand. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 5(4), 271-280. https://doi.org/10.17511/ijoso.2019.i04.07
Issue
Vol 5 No 4 (2019): Sep-Oct
Section
Original Article