A COMPREHENSIVE STUDY OF THE VARIOUS TECHNIQUES FOR MANAGEMENT OF CLOSED METACARPAL FRACTURES

Abstract

Background: Metacarpal fractures are one of the most common fractures of the upper extremity particularly involving young adults. The ideal treatment option for metacarpal fractures depend on the fracture location, fracture geometry and fracture stability. The objective of the study was to analyze the treatment outcome in closed metacarpal fractures treated by various conservative and operative modalities. Materials and Methods: 73 closed metacarpal fractures in 59 patients treated in a tertiary care medical teaching hospital between September 2015 and March 2019 were enrolled in the study. 7 patients were lost for followup leaving 52 patients with 65 metacarpal fractures for the final analysis. Conservative treatment with volar splint or thumb spica was the first line of treatment. Patients with unstable fracture patterns, irreducible deformity and significant shortening were treated by various surgical modalities. Belsky Criteria for assessment of finger injuries with special emphasis on Total Active Movement (TAM) of the involved finger was used to assess the results with clinical and radiological parameters at three months. Results: Conservative treatment with closed reduction and volar splint or thumb spica was used for 39 fractures (60%). Surgical treatment was used in 26 fractures (40%). The results with conservative management were 18 excellent results (46.15%), 17 good results (43.58%) and 4 poor results (10.2%). The results with the various surgical methods were 10 excellent results (38.46%), 12 good results (46.15%) and 4 poor results (15.38%). Complications in the conservative treatment group were 3 malunions, 2 cases with extensor lag and 4 cases with stiffness of the involved finger. Complications in the operative treatment group were 1 malunion, 3 cases with extensor lag, 2 patients with superficial pin infections and 4 cases with stiffness of the involved finger. Conclusion: Conservative treatment is the gold standard for treatment of metacarpal fractures. Fractures treated by this method are sufficiently stable to allow mobilization by 4 weeks thereby avoiding finger stiffness. In some carefully defined fracture patterns, surgical treatment gives the advantage of stability of fixation to allow early mobilization. The aim of the various surgical treatment methods should be to achieve results comparable to conservative treatment methods and not to replace conservative methods of treatment. Keywords: Metacarpal fracture, K-wire, Belsky Criteria, Total Active Motion (TAM)