Minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the base of the first metacarpal

Abstract

Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the first metacarpal base. Methods From September 2014 to April 2016, eleven patients with intra-articular fractures of the base of the first metacarpal were treated. All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction. Small incision was made for these that could not be fixed with closed reduction. Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction. The forearm was immobilized with a plaster cast. Results The time of fracture healing was 7 to 9 weeks, the average being 7.6 weeks. The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed. Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months. Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up, which revealed excellent results in 8 cases, good in 2 cases, and fair in 1 case. Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal, application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results. Key words: Metacarpal bones; External fixators; Intra-articular fracture; Comminuted fracture