Functional Outcome of Closed Metacarpal Fractures Treated with Mini Fragment Plates and Screws

Aim: To assess the functional outcome after metacarpal fracture fixation with mini fragment plates. Study design: Prospective cohort study Place and duration of study: Department of Orthopaedic Surgery, GTTH, Lahore from 01-01-2015 to 31-07-2020. Methodology: Sixteen patients who were operated with mini fragment plates for metacarpal fractures. Functional outcome was evaluated with help of American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF) score and the disabilities of the arm, shoulder. Results: Union was achieved in all patients. The functional outcome was excellent in 13 and good in 2 and poor in 1. Three cases of infection (all superficial) were noted, which settled with dressings and antibiotics. Conclusion: Mini fragment plates for metacarpals fractures are a good option, providing early mobilization and excellent functional outcome. Keywords: Functional outcome, Metacarpal fracture, Mini fragment plat, Open reduction internal fixation (ORIF)

First reported case of a coronal hamate fracture associated with intrusion of the fifth metacarpal base, together with a fracture of the fourth metacarpal base

We present a case reporting a rare combination of base of fourth metacarpal fracture and coronal body of hamate fracture, treated conservatively with excellent results. High index of suspicion for undetected bony injuries drove the execution of a CT scan, which allowed us to make a full correct diagnosis and plan treatment. Moreover, this case becomes the first reported case in the literature of such injury causing the intrusion of the base of the fifth metacarpal within the hamate bone, thus causing the coronal pattern of the hamate fracture. Differently from the common surgical management of this type of injury, we successfully treated this patient with close reduction and immobilisation, with full recovery after 3 months.

Corrective Osteotomies for Digital Overlap in Phalangeal and Metacarpal Fracture Malunion Using Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique: A Technical Note

The use of wide-awake local anesthesia with no tourniquet (WALANT) in surgical procedures of the hand is well described and extends to tendon surgery, carpal tunnel release, trapeziectomy and phalangeal fracture fixation. Its use has not been described in corrective osteotomies of phalangeal or metacarpal fracture malunion. In our series of five patients who underwent phalangeal and metacarpal osteotomies under WALANT, all of the patients achieved union at a mean of 3.5 months and were satisfied with the results. All digital malrotations were corrected. There was an improvement of motion and grip strength by 24% and 29.3% respectively compared to pre-surgery. Corrective osteotomies under WALANT is a safe and effective means of achieving correction of scissoring. With the patient wide awake and cooperating, precise correction of rotational alignment can be ascertained. Concomitant tenolysis allows motion gains to be made over and above the restoration of rotational alignment.

Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center. Methods: This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis. Results: Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient. Conclusions: Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.

Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument

Adequate positioning of the hand is a critical step in hand fracture operative repair that can impact both the clinical outcome and the efficiency of the operation. In this paper, we introduce the use of a thermoplastic splint with an added thumb stabilizing component as a means to increase the surgeon’s autonomy and to streamline the patient care pathway. The thermoplastic splint is custom fabricated preoperatively by the specialist hand therapist. The splint is used prior, during, and post operation with minimal modification. The thumb component assists maintaining the forearm in a stable pronated position whilst drilling and affixing metal work. This is demonstrated in the video of removal of metal work and open reduction and internal fixation of a metacarpal fracture.