Complications in surgical management of phalangeal and metacarpal fractures

Abstract

Background and Objectives: Hand fractures if not treated properly will result in deformity, stiffness and loss of function leading to functional deformity. Fracture healing in hand is not an isolated goal; rather it is the functional result that is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires and mini-external fixators as compared to the conservative treatment.Methods: This is a prospective study of 30 cases of metacarpal and phalangeal fractures treated surgically with mini-external fixators and K-wires, admitted to Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research Institute from Nov 2018 to Aug. 2019.Results: We followed up all the patients and the duration ranged from 12 weeks to 20 weeks (Mean 16 weeks). All fractures eventually united. We had totally 7 complications, which included superficial infection. (1), stiffness of MCP joints. (1), non-union. (2), mal-union. (2) and gangrene. (2) We had no case of any purely implant related complications like K-wire migration or pin-tract infection. Fifth and fourth metacarpals were most commonly involved in our series. Out of 30 patients 18 patients (60%) had excellent result, 8 patients (26.66%) had good result and 4 patients (13.33%) had poor result.Interpretation and Conclusion: Displaced metacarpal fractures treated surgically by mini-external fixator. K-wire gives excellent result in terms of union, recovery of daily activities and stiffness. There will be fewer chances of infection and early bone union in case of CRIF with K-wire than ORIF with K-wire. However, stiffness of hand joints, especially metacarpo-phalangeal joint is of major concern and physiotherapy plays a major role to combat stiffness.