[Treatment of metacarpal and phalangeal fractures--a review]

Isolated fractures of metacarpals and phalanges are the commonest injuries affected upper extremity, which constitute about 10% of skeletal fractures in general. They occur the most frequently in age between 10 and 40, so affect mostly children and young adults. Based no the literature from last two decades, the results of the treatment of these fractures with various methods are presented. Isolated and undisplaced fractures of the metacarpals and phalanges are usually managed conservatively using a plethora of methods of immobilization including elastic bandage, taping with neighbored finger, thermoplastic and plaster of Paris splints. Stable fractures with angular displacement require reduction or not, if dislocation is acceptable. Unstable and axially displaced fractures are usually treated operatively, however there is no enough scientific evidence that this option is more effective. Surgery for these fractures includes percutaneous fixation with K-wires introduced intramedullary or crossed, K-wires fixation with neighbored, unaffected metacarpal bone, open techniques such as lag screws and plates and external fixation. Phalangeal fractures are more frequently treated operatively, since they are commonly believed unstable what may result in malunion. The results of the treatment of fractures of metacarpals and phalanges are generally good, regardless the method which was used. The failures include nonunion, malunion which disturbs hand function or is cosmetically unacceptable, reduction of finger movement, degenerative changes in neighbored joints and algodystrophy. We stress that contemporary literature provides no evidence that either of the methods of the treatment of these fractures is superior, but rather suggests that they are equally effective. Common drawback of the quoted studies is lack of subjective assessment of the dexterity of the hand in daily and professional activity with standardized questionnaires.