Complications of Plate and Screw Fixation in Metacarpal Fractures

Czech version

Authors: Daniel Ira ¹; Jan Kovařík ²; Milan Krtička ¹; Michal Mašek ¹; Zbyněk Bortlíček ³
Authors‘ workplace: Department of Trauma Surgery, University Hospital Brno ¹; Klinika úrazové chirurgie Fakultní nemocnice Brno - Bohunice ¹; Department of Surgery, County Hospital Boskovice ²; Chirurgické oddělení nemocnice Boskovice ²; Institite of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of the Masaryk University ³; Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity Brno ³
Published in: Úraz chir. 18., 2010, č.1

Overview

Purpose:
The objective of this study is to assess the complications and functional results after open reduction and plate/screw fixation of meta-carpal fractures.

Methods:
From January 2005 to May 2009 114 patients with 128 metacarpal fractures (second to fifth metacarpal bone) were treated with open reduction and mini-plate/mini-screw internal fixation. Seventy-seven patients with 88 metacarpal fractures were available for final examination with minimal follow up of eight months. Seventy-one fractures were located in diaphysis, in 11 cases distal metacarpal segments and in 6 cases proximal segments were injured. Types of plates used for fixation included 33 straight plates, 8 T plates and 3 condylar plates. Forty-four fractures were stabilized only with lag screws. At the final follow-up clinical, radiological and questionnaire evaluation were performed. Complications classified according to Page and Stern were noticed and DASH questionnaire was used for subjective assessment. Complication occurrence and DASH values were correlated with the type of fixation material, types of fracture and isolated or multiple fractures. Fishers exact test, ML chisquare test, non parametric Mann-Whitney test and Kruskal-Wallis test were used for the statistic analysis.

Results:
Twenty-two of 77 patients (28.5 %) and 24 of 88 fractures (27 %) had one or more complications. Internal fixations of distal meta-carpal segment were found to have statistically significant higher rate of complications and lower DASH values. The complication rate and DASH values were higher when plate fixations were performed in comparison with lag screw fixations. There was no statistically significant correlation between isolated and multiple fractures.

Conclusions:
Fixation of proximal and medial segment metacarpal fractures using mini-plates and mini-screws is appropriate treatment choice in case of correct indication criteria, adequate surgical technique and early rehabilitation. Despite anatomical reduction and early postoperative rehabilitation, functional results of open reduction and internal fixation of distal segment metacarpal fractures are not satisfactory. Benefits of closed miniinvasive techniques or brace conservative treatment in distal segment fractures in comparison with open methods are concerns of our further research.

Key words:
metacarpal fracture, internal fixa-tion, complication.

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Labels

Surgery Traumatology Trauma surgery

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Article was published in

Trauma Surgery

2010 Issue 1