A prospective study to evaluate the functional outcome of metacarpal shaft fracture treated with mini plates

Abstract

Background: Metacarpal fractures are among the most common fractures of the hand. They may lead to loss of function if treated improperly. These injuries can be treated conservatively. However, if significant shortening, rotational deformity and angulation occur, surgical treatment is required. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using miniplates and screws as compared to the conservative treatment or K –wire fixation. Hence the study aims to assess the functional outcomes of patients with metacarpal fractures, who will be undergoing open reduction and fixation with low profile titanium plates in our department.Materials and Methods: Patients coming to the Department of Orthopaedic, at Sri Siddhartha MedicalCollege, Tumakuru with metacarpal shaft fractures who are treated with open reduction and internal fixation with mini-plate. All patients are operated in supine position and under infraclavicular block or general anesthesia. After the tourniquet is inflated, the forearm is placed in pronation, a dorsal longitudinal incision is made and the fracture is exposed with adequate soft tissue dissection. A low profile 2.0 mm titanium miniplate is applied with four screws, two on each side of the fracture. In oblique or spiral type of fractures, initially fixed with inter fragmentary screws and then by plate. Metacarpal alignment and angulation will be confirmed with fluoroscopy. The plate and screws was covered with periosteum and soft tissues.Results: The maximum subjects had injury on the right side (58.3%) and commones tbone to be involved was fracture of shaft of 5th metacarpal (37.5%). Transverse type (39.6%) was the commonest fracture pattern. Our study showed excellent functional outcome (54.2%) with lower complication rates and bone union was seen in minimum 6 weeks. Mean DASH score at 1 month (18.56), 3 month (11.56),6 months(3.02) with p value = 0.001.Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results. Detailed clinical and radiological assessment of fracture, careful preoperative planning, meticulous dissection, precision in surgical technique (coverage of plate with soft tissue) and choosing the correct implant (low profile plate) are critical in achieving good results and minimizing the complication.