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Category: Volume 09 Issue 10 October 2021
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Title: Fixation of unstable diaphyseal metacarpal fractures with low profile locking plates: Case series-Current concepts

Authors: Kastanis G, Magarakis G, Kapsetakis P, Pantouvaki A

 DOI: https://dx.doi.org/10.18535/jmscr/v9i10.01

Abstract

Metacarpal shaft fractures are a common injury in emergency department, the majority of which are stable injuries that can be treated conservatively with excellent functional results. Injuries, characterized as unstable, need operative management. The aim of this study is to answer the question: is the plate fixation technique the most efficient surgical method for unstable diaphyseal metacarpal fractures, analyzing our functional outcomes in long term period based on time to fracture union, complications and final patient’s satisfaction.

Material & Methods: One hundred two patients with 128 unstable metacarpal fractures with an average age of 32,5 years old (range from 22 to 48) were stabilized by low profile plate (locking or convectional)  due to unstable metacarpal fracture. Isolated metacarpal fractures appear in 75,5% of cases while multiple metacarpals involved in 24,5%. In 15,7% of the cases the fracture was open classified by Gustilo & Anderson as Grade I. All patients were operated within the first two weeks from the injury. The approach was dorsal between the spaces of involved metacarpals except in fractures of fifth metacarpal which it was dorsoulnar.

Results: The mean follow-up is about 16,8 months (range from 13 months to 28 months). Results were evaluated according to fracture union, complication, grip strength, completion of VAS score, Quick Dash Score and American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF). Mean score of pain at final examination according to Visual Analogue Scale was 0, 29+1,08, grip strength was a mean of 92,8% of the uninjured hand, Quick DASH was 6,8+5,4. The ASSH TAF was excellent in 76 cases (TAF range from 250-280), good in 24 cases TAF range from 185°-210°) and fair in two cases (TAF were 80° and 75°).

Conclusion: Low profile locking plates offer stable and rigid fixation of the fracture which allow early mobilization and enhance hand functionality. As a surgical method presents complications and in order to avoid all these problems, before the application of locking plate technique, two important factors must be considered: factors according to the fracture pattern, and patients’ factors. A second operation to remove the plate should always be on the surgeon's mind when there is evidence of adhesion or joint stiffness.

Keywords: Metacarpal fracture, shaft metacarpal fracture, mini locking plate, internal fixation, complication.

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Corresponding Author

Grigorios Kastanis

Reconstructive Hand Surgery Unit, General Hospital of Heraklion –Venizeleio, Crete, Greece