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 60 cases of metacarpal and phalangeal fractures treated surgically with mini-external fixators and K-wires, admitted to Bowring and Lady Curzon Hospital and Victoria Hospital attached to Bangalore Medical College and Research Institute from Oct. 2017 to Sep. 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 60 patients 33 patients (54.54%) had excellent result, 19 patients (31.81%) had good result and 8 patients (13 .63%) 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. Keywords: Fracture, Metacarpal, Phalanges
Highlights
In our study we are dealing with patients with metacarpal fractures treated with mini external fixators, ORIF with K-wire, CRIF with K-wire percutaneously under image intensifier
Out of total 60 cases of metacarpal fractures, 40 cases were treated with K-wire of which 32 were closed reduced under C-arm guidance, 8 were opened, 4 cases were treated with external fixators, and remaining cases were managed conservatively
2 patients treated with ORIF with K-wire fixation had superficial infection, which was treated with appropriate antibiotics and regular dressing
Summary
To prevent the complications of open reduction and internal fixation like infection, soft tissue trauma, etc., and with the advent of image intensifier CRIF with K-wire percutaneously under image intensifier has given better results, faster healing, faster return of daily activities and faster rehabilitation.[1,8] Early and appropriate physiotherapy other than accurate reduction and fixation affect recovery of hand mobility and function.[5,6] In our study we are dealing with patients with metacarpal fractures treated with mini external fixators, ORIF with K-wire, CRIF with K-wire percutaneously under image intensifier. 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. Stiffness of hand joints, especially metacarpo-phalangeal joint is of major concern and physiotherapy plays a major role to combat stiffness
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