Functional Outcome after Surgical Fixation of Metacarpal and Phalangeal Fractures using K Wire
Keywords:Metacarpal fractures, Phalangeal fractures, K- wire fixation
AbstractBackground: Metacarpal and phalangeal fractures are commonly encountered fractures, majority of them are stable and can be treated by non-operative means, however, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures by K-wire using different techniques. Materials and Methods: A prospective study was conducted between December 2010 and October 2012. Seventeen patients with 21 unstable metacarpal and phalangeal fractures were treated by surgical stabilization using K-wire with different techniques. Fractures of the thumb and distal phalanx were excluded. All the patients were followed up for a minimum of three months. They were assessed radiologically and clinically. The evaluation of the functional outcome was measured according to Belsky's criteria. Results: All fractures achieved union with a mean of 8.5 weeks, no delayed union or nonunion or infection was reported, but stiffness has happened in 4(19%) fractures and mal-union in 2(10%) cases. Overall functional results were excellent to good in 17(81%) of cases and fair to poor in 4(19%) of cases .A better functional outcome was achieved in metacarpal fractures with excellent - good in (85%) as compared with phalangeal fractures with good results in (75%), Closed fractures (93%) excellent - good as compared to compound fractures with (50%) good results. Conclusion: K-wire is a sound method of fixation for unstable metacarpal and phalangeal fractures that could give good results, regarding fracture union, functional outcome, with low complication rate. Metacarpal and closed fractures show a better functional outcome than phalangeal& compound fractures.
Stern PJ. Fractures of metacarpal and phalanges. In: Green DP, Hotchkiss RN, Pederson WC ,et al ,editors.Green's operative hand surgery.4th edition. Philadelphia: Churchill Livingstone. 1999; 711-71.
McNemar TB, Howell JW, Chang E. Management of metacarpal fractures. J Hand Ther 2003; 16: 143-51.
Hove LM. Fractures of the hands. Distribution and relative incidence. Scand J Plast Reconst Surg 1993; 27: 317-9.
Swanson AB. Fractures involving the digits of the hand. Orthop Clin North Am 1970; 1: 261-74.
Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 2006; 22: 287–295.
Kurzen P, Fusetti C, et al. Complications after plate fixation of phalangeal fractures. J Trauma 2006; 60: 841–843.
Belsky,Richard G Eaton,and Lewis B Lane . Closed reduction and internal fixation of proximal phalangeal fractures, journal of hand surgery,1984; vol.9A:725-9.
Drenth DJ, Klasen HJ. External fixation for phalangeal and metacarpal fractures. J Bone Joint Surg [Br]. 1998 Mar; 80(2): 227-230.
Mark H.Gonzales,William Mckay ,Robert F. Hall Jr. Low velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone graft. Journal of hand surgery Am, 1993 March; 18(2):267-70.
Orbay J. Intramedullary nailing of metacarpal shaft fractures. Tech Hand Up Extrem Surg. 2005 Jun; 9(2): 69-73.
Riazuddin Mohammed, Mohamed Z Farook , and Kevin Newman Percutaneous elastic intramedullary nailing of metacarpal fractures.Journal of Orthopedic Surgery and Research 2011, 6:37.
Hyder Ali, Atif Rafique, Mabroor Bhatti, Shahab Ghani, Moiz Sadiq, Shehab Afzal Beg. Management of Fractures of Metacarpals and Phalanges and associated risk factors for delayed healing, J Pak Med Assoc.2007 February; 57 ( 2) : 64-66.
Amit Thakur. Operative Management of Metacarpal and Phalangeal Fractures. JK Science 2008 January-March ; 10 ( 1);
Somboon Wutphiriya. Comparison of Miniplate and K-wire in Treatment of Metacarpal and Phalangeal Fractures, The THAI Journal of SURGERY 2009; 30:5-10.
Hemant Patankar and Fayaz W Meman. Multiple intramedullary nailing of proximal phalangeal fractures of hand, Indian J Orthop. 2008 Jul-Sep; 42(3): 342–46.
Rakesh Gupta ,Roop Singh,RC Swach,SS Sangwan,Narender K Magu and Rahul Diwan. Evaluation of surgical stabilization of metacarpal and phalangeal fractures of hand ,IJO .2007 Jul-Sep;41(3):224-29.