Functional outcome of metacarpal and phalangeal fractures treated with open reduction and internal fixation using plates and screws in a tertiary level hospital

Abstract

Introduction: Metacarpal and phalangeal fractures are common injuries encountered in orthopaedic practice. Traditionally, these fractures needing operative treatment have been managed with closed reduction and percutaneous pinning with various wire positions/configurations. Operative treatment, plate and screw fixation provides superior biomechanical strength compared to k wire.
Objectives: To evaluate the functional outcome of metacarpal and phalangeal fractures treated with open reduction and fixation with screws with or without plates.
Methodology: The study was conducted in KMC Teaching Hospital, Sinamangal, Department of Orthopaedics. The study included 36 metacarpal and 11 phalangeal fracture cases in 38 patients. All included patients were operated with open reduction and internal fixation with 1.5 mm mini plate systems. Both metacarpal and phalangeal fracture were treated with dorsal approach. Patients were discharged on second post operative day after wound inspection. Functional outcome was evaluated with DASH scoring system at six weeks, three months, and six months post operatively.
Results: Out of 38 patients two were lost to follow-up. Among 36 patients at six weeks post-surgery, average DASH score was 63.18±15.3. This score improved to an average of 32.62±16.15 and 4.23±5.97 at three months and six months respectively. Among 44 bones fixed, 31 bones showed radiological union at the end of three months. One case did not show union at six months.
Conclusion: Mini plate and screw constructs provide superior biomechanical strength. Hence, rigid stable fixation provided by plating allowed early mobilization and achieved good functional results. Proper preoperative planning and sharp dissection with meticulous handling of soft tissue minimize complications.