A Prospective Study of Closed Metacarpal Fractures and Comparison of Treatment Modalities
Journal Title: Journal of Trauma and Orthopaedic Surgery - Year 2018, Vol 0, Issue 0
Abstract
Background and Objectives: 104 Metacarpal fractures in 78 patients were treated at our institution from September 2010 to May 2017, with the objective of studying clinically and radiologically, the incidence, mechanism of injury, types of fracture and various treatment aspects. Results were compared to assess the efficacy of different treatment modalities and compare their functional outcomes of the closed metacarpal fractures of hand. Materials and methods: 104 metacarpal fractures in 78 patients were enrolled from September 2010 to May 2017. The treatment modalities were broadly categorized into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment. Group A included 41 fractures treated with cock-up splint (n=32) and thumb spica (n=9), while 63 fractures were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=42), OR and IF with miniplate and screws or miniscrews alone (n=15), and mini external fixator (n=6). Total active range of motion as suggested by the American society for surgery of hand and Gingrass’s criteria were used for functional assessment and to assess the efficacy of conservative and surgical modalities for closed metacarpal fractures of the hand. Results: Final evaluation of the patients done at the end of three months. The excellent to good results seen in Group A and B were 80.5% and 87.3%, respectively. Seven complications were seen in Group A, which included four cases with malunion and three cases with stiffness. Six complications were seen in Group B, which included four cases with stiffness and one each of pin tract infection and operative wound infection. Conclusion: Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery. Surgical modalities have distinct advantage of stable fixation but with added risk of stiffness. Both conservative and surgical modalities have good efficacy when used judiciously. Single fractures have shown better grade of total active range of motion compared to multiple fractures. Treatment objective may be compromised if post-treatment physiotherapy and rehabilitation using systemic protocol is not followed.
Authors and Affiliations
Jignesh Patel, Parag Tank, Vijay Patel, Purushotham Sastry
Keywords
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- EP ID EP631605
- DOI 10.13107/jto.2018.v05i01.104
- Views 53
- Downloads 0
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