Abstract
Introduction
We aimed to compare results of treatment of oblique–spiral metacarpal and phalangeal fractures with screw only or mini plate plus screw, respectively.
Methods
A total of 43 patients who were operated with a diagnosis of displaced, irreducible, unstable, rotational oblique–spiral metacarpal and proximal phalangeal fracture between 2007 and 2010 were included in this study. The mean age of patients with a phalangeal fracture was 33.8 years (range 20–50 years; 4 females, 18 males), and the mean age of patients with a metacarpal fracture was 29.6 years (range 18–45 years; 3 females, 18 males). Mini plate plus screw or screw only was used for internal fixation of these fractures. The patients were followed up for 19.2 ± 5.4 months in the phalangeal fracture group and 20.9 ± 7.3 months in metacarpal fracture group. Of the metacarpal fractures, 14 were oblique and 10 spiral, whereas 14 of the phalangeal fractures were oblique and 8 spiral. The patients were evaluated according to total range of motion of the finger, grasping strength and Q-DASH score.
Results
For patients treated with mini plate plus screw after metacarpal and phalangeal fractures, the time to return to work was significantly shorter in comparison to patients treated with screws only. There was no significant difference between patients with metacarpal fractures treated with mini plate plus screw and patients treated with screw only in terms of total range of motion and Q-DASH results at last on control examination, while results of patients with phalangeal fractures treated with screw only were significantly better. There was no significant difference between these two treatments in phalangeal fractures in terms of grasping strength of the finger in early (1st month) and late (last control examination), whereas patients with metacarpal fractures treated with mini plate plus screw reached higher grasping strength earlier.
Conclusion
Treatment with mini plate plus screw should be avoided in spiral and oblique phalangeal fractures, and fixation should be done with screw only with a short surgical incision and dissection. On the other hand, treatment with mini plate plus screw should be preferred in patients with spiral and oblique metacarpal fractures, especially in those who work in occupations requiring higher physical strength.
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References
Henry MH (2006) Fractures and dislocations in the hand. In: Bucholz RW, Beckman JD, Court-Brown CM (eds) Rockwood and Green’s fractures in adults, vol 1, 6th edn. Lippincott, New York, pp 772–855
Stern PJ (2005) Fractures of the metacarpals and phalanges. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW (eds) Green’s operative hand surgery, vol 1, 5th edn. Elsevier Churchill Livingstone, Philadelphia, pp 286–294
Agarwal AK, Pickford MA (2006) Experience with a new ultralow-profile osteosynthesis system for fractures of the metacarpals and phalanges. Ann Plast Surg 57:206–212
Kawamura K, Chung KC (2006) Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 22:287–295
Nalbantoğlu U, Gereli A, Kocaoğlu B, Aktaş S, Seyhan M (2007) Surgical treatment of unstable fracture-dislocations of the proximal interphalangeal joint. Acta Orthop Traumatol Turc 41:373–379
Adams JE, Miller T, Rizzo M (2013) The biomechanics of fixation techniques for hand Fractures. Hand Clin 29:493–500
Carpenter S, Rohde RS (2013) Treatment of phalangeal fractures. Hand Clin 29:519–534
Freeland AE, Geissler WB, Weiss AP (2001) Operative treatment of common displaced and unstable fractures of the hand. J Bone Joint Surg Am 83:928–945
Duncan RW, Freeland AE, Jabaley ME, Meydrech EF (1993) Open hand fractures: an analysis of the recovery of active motion and of complications. J Hand Surg Am 18:387–394
Bannasch H, Heermann AK, Iblher N, Momeni A, Schulte-Mönting J, Stark GB (2010) Ten years stable internal fixation of metacarpal and phalangeal hand fractures-risk factor and outcome analysis show no increase of complications in the treatment of open compared with closed fractures. J Trauma 68:624–628
Curtin CM, Chung KC (2002) Use of eight-hole titanium miniplates for unstable phalangeal Fractures. Ann Plast Surg 49:580–586
Lu WW, Furumachi K, Ip WY, Chow SP (1996) Fixation for comminuted phalangeal Fractures. J Hand Surg Br 21:765–767
Massengill JB, Alexander HA, Langrana N, Mylod A (1982) A phalangeal fracture model—quantitative analysis of rigidity and failure. J Hand Surg Am 7:264–270
Takigami H, Sakano H, Saito T (2010) Internal fixation with the low profile plate system compared with Kirschner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures. Hand Surg 15:1–6
Black DM, Mann RJ, Constine RM, Daniels AU (1986) The stability of internal fixation in the proximal phalanx. J Hand Surg Am 11:672–677
Gupta R, Singh R, Siwach RC, Sangwan SS, Magu NK, Diwan R (2007) Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand. Indian J Orthop 41:224–229
Trevisan C, Morganti A, Casiraghi A, Marinoni EC (2004) Low severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 124:675–680
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Başar, H., Başar, B., Başçı, O. et al. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only. Arch Orthop Trauma Surg 135, 499–504 (2015). https://doi.org/10.1007/s00402-015-2164-3
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DOI: https://doi.org/10.1007/s00402-015-2164-3