Comparative study of open reduction and internal fixation in fractures of metacarpal and proximal phalanx with Kirschner′s wire and miniplate

Abstract

Background: There is a rising trend in the use of miniplates over Kirschner's wire for treating hand fractures. The improved system of internal fixation by miniplates has many advantages over the Kirschner's wire. The purpose of this prospective study was to evaluate the differences between these two commonly used methods of internal fixation in fractures of proximal phalanges and metacarpals in terms of radiological union and functional outcome. Patients and Methods: The study included a total of 40 patients with a mean age of 35.72 years. The patients excluded from the study included those with a compound injury, severe osteoporosis, and severe co-morbid conditions. The patients were divided into two groups (Group A - treated with Kirschner's wire and Group B - treated with miniplate) with 20 cases each. The outcomes of treatment were compared in the two groups using Student's t-test and chi-square test. Results: The average time for radiological union in Group A (Kirschner's wire) was 8 weeks, while it was 8.7 weeks in Group B (miniplate). There was no statistically significant difference in the radiological union time between the two groups (P = 0.464, chi-square = 1.532). Stiffness was the most common associated complication in this study. It was more common in the group treated with Kirschner's wire (30%) compared to the group treated with mini fragment plating (20%). In Group A, 75% of cases had shown good to excellent results; while in Group B, 85% of the cases had similar result. There was no statistically significant difference (P = 0.737, chi-square = 1.268) in outcome in both groups.Conclusions: Both Kirschner's wire and miniplate are good methods of internal fixation in fractures of metacarpal and proximal phalanx. Though patients who were treated with miniplating had better functional results, but the difference was not statistically significant.