Management Of Metacarpal Fractures Research Articles

Comparison between two methods of fixation of Second and Third Metacarpal shaft Fractures: A Meta-analysis

ABSTRACT:Background: Metacarpal bone fractures considered one of the common skeletal fractures, accounting for 36% of all hand and wrist fractures.Patients and Methods: Only clinical studies of both methods used in the management of closed fractures of the second and third metacarpals were included in this review. It also included studies comparing open reduction and int. fixation with plate and screws Vs. percutaneous crossed K -wire fixation for metacarpal fractures. The Ten papers included in the systematic review and meta – analysis were retrospective cohort studies published between 2003 and 2019. The aim of this study is to evaluate the final results and postoperative complications for two methods of fixation within the treatment of fractures of Second and Third metacarpal bones: fixation with plate and screws Vs. percutaneous crossed K -wire.Results: No specifications used for the pattern of fracture, except for the fractures involving shaft of the second and the third metacarpals. All fractures needed to be operated due to deformity, angulations or rotation. No correlation could be done between types of fracture (i.e., spiral, oblique) and functional outcome. As all studies disscused the same indication for intervention, and on the other side, a correlation between type of fixation and functional outcome could be done.Conclusion: No recommendation made that one fixation technique is superior to another, and the complications associated with ORIF or k -wire fixation in the management of metacarpal fractures are distinct.Key words: Open Reduction - Internal Fixation - Percutaneous Kirschner Wires Fixation- fracture 2nd and 3rd metacarpalsFinancial disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.

The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures

ObjectiveWe aimed to compare the effectiveness of point-of-care ultrasonography (POCUS) with direct radiography (DR) in the diagnosis and management of the patients with metacarpal fractures (MFs). MethodsPatients between ages 5 and 55 years admitted to the emergency department with suspected MFs were included to the study. Emergency physicians (EPs) participating in the study were divided into 2 groups (POCUS, DR). Patients were evaluated by one of the EPs from each group. The EP performing the POCUS examination was blinded to the radiograph results. ResultsA total of 66 patients with MFs were included to the study. Fracture was determined in 36 (55%) patients with DR and in 37 (56%) patients with POCUS. When compared with radiography, the sensitivity of fracture detection with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 90% (95% confidence interval, 80%-98%). Sensitivity of detecting localization of the fracture with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 89% (95% confidence interval, 80%-98%). Of the patients with fracture, 69% have angulation and 24% have step-off determined with POCUS. Specificity of POCUS in the decision for treatment choice was 100%, and sensitivity was 99%. ConclusionWe found that POCUS could be applied easily with success by EPs in diagnosing MFs, determining the type of the fracture and required treatment methods correctly. Point-of-care US can be used to rule out a suspected MF, thereby avoiding the time and expense of radiography.

Effects of postoperative early motion on the results of osteosynthesis with miniplates in metacarpal fractures

Objectives: In our study, we aimed to evaluate the radiological and functional results of rigid internal fixation with mini plate osteosynthesis in the management of metacarpal fractures. Methods: In this study, 11 patients (10 males, 1 female) which were treated with mini plate osteosynthesis for metacarpal fracture (n=13) were evaluated retrospectively. The average age of patients was 35 years (range 25-46 years) with a mean follow-up of 1.4 years (range 1.1 to 2.2-years). Rehabilitation program was started on the postoperative second day. Range of motion was assessed according to the total active range of motion (TAROM) scale. Results: Eight patients (10 metacarpal) had excellent scores, two patients had good scores and one patient had moderate score at final follow-up. Time to union was found an average of 6 weeks (range 4-7 weeks). Complications did not observed such as loss of reduction, infection, circulatory disorders, neurological symptoms, osteonecrosis, sudeck atrophy. Conclusion: Rigid internal fixation with mini plate osteosynthesis could be performed in patients with metacarpal fractures with satisfactory radiological and functional results along with rehabilitation program contains passive and active joint movements initiated at early post-operative period.

Results of locked flexible intramedullary nailing of metacarpal fractures: a case series.

We present our case series on the use of flexible locked intramedullary nails in the management of metacarpal fractures. This was a prospective study over a period of 2years of all patients with metacarpal fractures with 100% displacement or rotational deformity operated by the flexible locked intramedullary nails from January 2008 to April 2010 at Queen Elizabeth Hospital, Gateshead, UK RESULTS: Twenty-six patients with fractures of metacarpal neck and shaft were included in the study. All fractures went on to union by an average of 6.3weeks with full metacarpophalangeal joint movement and grip strength. In our experience, this device helps to achieve good functional results with minimal soft tissue disruption and complications in the management of unstable metacarpal fractures.