Abstract
Introduction
The results reported in the literature of metacarpal and phalangeal fractures treated with miniature plates and screws are scarce and contradictory. The aim of our study was to evaluate the functional results after low-severity metacarpal and phalangeal fractures treated by miniature plates and screws.
Materials and methods
We retrospectively reviewed 44 patients of a consecutive series with 56 low-severity metacarpal and/or phalangeal fractures stabilized with miniature plates and screws with a mean follow-up of 24 months to assess objective and subjective outcomes and complications. The objective assessment included measurement of the range of motion (ROM) of the involved finger, prehension, sensory function and strength. The subjective evaluation assessed the impairment and pain felt by the patient.
Results
At the final check-up, average total active movement of the involved digit was 256° (range 175°–260°), and average score for prehension was 49.3 (range 30–50), with 41 patients with a full score. The Jamar test pointed to a significant reduction in grip strength (−5.2%) of the injured hand compared with the other hand. Average subjective impairment score for all the fractures was 15.5 (range 10–16), with 39 patients having a score between 16 and 14 (no impairment). Fracture reduction was anatomic in 42 fractures (75%), satisfactory in 11 (19.6%) and unsatisfactory in 3 (5.4%). There were no contractures, non-unions, infections or tendon ruptures. Twenty patients (45%) presented with one or more complications in 23 fractures (41.1%).
Conclusion
These very favourable results suggest that miniature plates and screws are a possible choice in the treatment of these fractures.
Similar content being viewed by others
References
Belski MR, Eaton RG, Lane LB (1984) Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg Am 9:725–729
Bosscha K, Snellen J (1993) Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study. Injury 24:166–168
Brefort G, Condamine JL, Aubriot JH (1986) Functional results of seventy-six cases of phalangeal and metacarpal fractures studied using a hand emergency computer card system. Ann Chir Main 5:25–35
Chen SH-T, Wie F, Chen H, Chuang C, Noordhoff S (1994) Miniature plates and screws in acute complex hand injury. J Trauma 37:237–242
Chow SP, Pun WK, So YC, Luk KDK, Chiu KY, Ng KH, Ng C, Crosby C (1991) A prospective study of 245 open digital fractures of the hand. J Hand Surg Br 16:137–140
Dabezies EJ, Schutte JP (1986) Fixation of metacarpal and phalangeal fractures with miniature plates and screws. J Hand Surg Am 11:283–288
Diwaker HN, Stothard J (1986) The role of internal fixation in closed fractures of the proximal phalanges and metacarpals in adults. J Hand Surg Br 11:103–108
Ford DJ, el-Hadidi S, Lunn PG, Burke FD (1987) Fractures of the metacarpals: treatment by AO screw and plate fixation. J Hand Surg Br 12:34–37
Ford DJ, el-Hadidi S, Lunn PG, Burke FD (1987) Fractures of the phalanges: results of internal fixation using 1.5 mm and 2 mm AO screws. J Hand Surg Br 12:28–33
Freeland AE, Geissler WB, Weiss AP (2001) Operative treatment of common displaced and unstable fractures of the hand. J Bone Joint Surg Am 83:928–945
Fyfe IS, Mason S (1979) The mechanical stability of internal fixation of fractured phalanges. Hand 11:50–54
Hastings H (1987) Unstable metacarpal and phalangeal fracture treatment with screws and plates. Clin Orthop 214:37–52
Heim U, Pfeiffer KM, Meuli HC (1973) Resultate von 332 A.O. Osteosynthesen des Handskelettes. Handchirurgie 5:71–77
James JIP (1962) Fractures of the proximal and middle phalanges of the finger. Acta Orthop Scand 32:401–412
Mann RJ, Black DM, Constine RM, Daniels AU (1985) A quantitative comparison of metacarpal fracture stability with five different methods of internal fixation. J Hand Surg Am 10:1024–1028
Massengil JE, Alexander H, Lagrana N, Mylod A (1982) A phalangeal fracture model—quantitative analysis of rigidity and failure. J Hand Surg 17:264–270
Ouellette EA, Freeland AE (1996) Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthop 327:38–46
Page SM, Stern PJ (1998) Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am 23:827–832
Pun WK, Chow SP, So YC et al (1991) Unstable phalangeal fractures: treatment by A.O. screw and plate fixation. J Hand Surg Am 16:113–117
Ruedi TP, Burri C, Pfeiffer KM (1971) Stable internal fixation of fractures of the hand. J Trauma 11:381–389
Stern PJ, Wieser MJ, Reilly DG (1987) Complications of plate fixation in the hand skeleton. Clin Orthop 214:59–65
Tscherne H, Oestern H-J (1982) Die Weichteilbehandlung bei Osteosynthesen, insbesondere bei offenen und geschlossenen Frakturen. Unfallenhielkunde 85:11–15
Vanik RK, Weber RC, Matloub HS, Sanger JR, Gingrass RP (1984) The comparative strengths of internal fixation techniques. J Hand Surg Am 9:216–221
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trevisan, C., Morganti, A., Casiraghi, A. et al. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 124, 675–680 (2004). https://doi.org/10.1007/s00402-004-0745-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-004-0745-7