Clinical results of absorbable plates for displaced metacarpal fractures
Clemens Dumont1, Michael Fuchs, Helmut Burchhardt
1Department of Trauma Surgery, Plastic and Reconstructive Surgery, Göttingen University, Göttingen, and the Trauma and Orthopaedic Surgery and Sports Injury Clinic, Friedrich Ebert Hospital, Neumünster, Germany. clemens.dumont@med.uni-goettingen.de
Purpose:
To present the clinical results of a study of unstable metacarpal fractures treated with absorbable plates.
Methods:
Between July 2004 and June 2006, 12 patients (14 fractures) who presented with displaced, unstable, metacarpal fractures had open reduction and internal fixation. The overall clinical follow-up results and radiographic controls at 6, 12, and 26 weeks after surgery are reported. The clinical outcome was assessed by the Disabilities of the Arm, Shoulder, and Hand score and the visual analogue pain scale.
Results:
The involved fingers showed an average final total active motion of 234 degrees (range, 220 degrees-265 degrees). No deformity of rotation>5 degrees was observed in any patient in the clinical follow-up evaluation. One patient had a loss of reduction with a palmar angle of the metacarpal axis of 20 degrees in the sagittal plane. A second patient with secondary loss of reduction required surgical revision, at which time internal fixation was performed by using a titanium plate. Complications included keloid formation and prolonged soft-tissue swelling for more than 6 weeks in 3 patients. No wound margin necrosis, infection, pseudarthrosis, sinus formation, or osteolysis was observed. Bone consolidation was achieved reliably within 6 weeks both clinically and radiologically. The Disabilities of the Arm, Shoulder, and Hand score results 6 weeks after surgery were an average of 30 points compared with 13 after 12 weeks and 3 points after 26 weeks. The visual pain scale showed mean values of 18 after 6 weeks, 2 after 12 weeks, and 0.2 after 26 weeks.
Conclusions:
Absorbable plates are suitable for use in hand surgery and allow early range of motion in combination with an additional orthosis of the hand (as described) for 3 weeks. In the early and medium-term postoperative course, no osteolysis or sterile sinus formation was observed. Metal plates are still the gold standard; however, surgical implants made of amorphous copolymer of L-lactide and glycolic acid in combination with an orthosis constitute a useful and reliable means of metacarpal fracture treatment.
Type Of Study/Level Of Evidence:
Therapeutic IV.
