[Treatment of metacarpal fractures with open reduction and low-profile plate and screw fixation]
Ufuk Nalbantoğlu1, Arel Gereli, Bekir Yavuz Uçar
1Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery (Ortopedi ve Travmatoloji Bölümü, El ve Ust Ekstremite Cerrahisi Servisi), Acibadem Kadiköy Hospital, Istanbul, Turkey.
Objectives:
We evaluated functional results and effectiveness of open reduction and low-profile plate fixation for the treatment of low-severity metacarpal fractures.
Methods:
We retrospectively reviewed 50 metacarpal fractures of 43 patients (37 men, 6 women; mean age 31+/-9 years; range 17 to 52 years) who were treated with open reduction and low-profile plate fixation. Fractures of the first metacarpal were excluded. There were 26 oblique, 12 transverse, and 12 comminuted fractures. Three fractures were open. Objective assessment included total active motion (TARM) and grip strength. Subjective assessment was made using the Turkish version of the Quick-DASH scale. Radiographic evaluations were made on anteroposterior/lateral and oblique roentgenograms. Complications were classified as major or minor according to the Page-Stern system. The mean follow-up was 62.2+/-24.8 months (range 12 to 96 months).
Results:
At final evaluations, the mean TARM was 220.5+/-43.9 degrees (range 30 degrees to 260 degrees ). The results were excellent in 25 patients (58.1%), good in 12 patients (27.9%), fair in five patients (11.6%), and poor in one patient (2.3%). The mean loss of grip strength was 5.2+/-7.3%. The mean Quick-DASH score was 2.0+/-2.8 (range 0 to 11). All fractures were united. Ten patients had major complications (23.2%), which included extensor tenosynovitis and plate-related discomfort requiring plate removal in four patients (9.3%), and less than 180 degrees of TARM in six patients (14%).
Conclusion:
Low-severity metacarpal fractures can be treated successfully with open reduction and low-profile plate fixation, allowing early and safe functional use.
