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2009 | 81 | 5 | 217-224
Article title

Conservative vs Operative (Fixation with K-wires) Treatment of Isolated Fractures of Metacarpal Bones - Results of the Prospective, Randomized Study

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EN
Abstracts
EN
Hand fractures (phalanges and metacarpals) are very common and they constitute a cause of considerable ambulatory and surgical departments workload. Isolated, undisplaced and displaced but stable fractures are usually treated non-operatively, and classical indication to surgery are unstable, oblique, spiral, intra-articular, open and complex fractures. Results of some studies suggest that oblique, spiral and apparently unstable fractures can be successfully treated conservatively, questioning afore-mentioned indications to surgeryThe aim of this prospective and randomized study was to compare the results of conservative versus operative (by fixation with K-wires) treatment of isolated, displaced and extra-articular metacarpal fractures.Material and methods. Forty-seven patients, 36 male (77%) and 11 female (23%) with a mean age of 34 years (range 16-75), with isolated metacarpal fractures, were randomly allocated to operative, by intramedullary fixation with K-wires (24 patients), or conservative, by reduction and immobilization (23 patients) treatment. Patients were followed-up at 2 and 6 months, and the assessments included measurements of active range of motion of fingers, total grip and pinch strengths, angular deformity on X-rays and subjective hand function with DASH questionnaire.Results. In one patient (4%) treated conservatively, an unacceptable secondary displacement occurred, and he was withdrawn from the study. and given surgical treatment. All fractures consolidated. At 2 months assessment, no statistically significant differences between the variables in the operative and conservative treatment groups were noted, except of the angular deformity on X-rays, which was significantly greater after conservative than operative treatment (median 31° vs 9°). At 6 months assessment, an active range of motion of involved fingers was statistically significantly greater in operative, than in conservative treatment group (median 269° vs 250°) and the angular deformity was significantly lesser after operative than conservative treatment (median 24° vs 12°). There were no statistically significant differences between the groups with regard other analysed parameters. None healing disturbances and malrotations were noted.Conclusions. The results of this study indicate the equal effectiveness of both the operative by K-wiring, and conservative treatment of fractures of the metacarpals. The better anatomical outcomes in terms of the degree of angular deformity did not translate directly into the better function of the hand.
Publisher

Year
Volume
81
Issue
5
Pages
217-224
Physical description
Dates
published
1 - 5 - 2009
online
8 - 9 - 2009
Contributors
  • Department of General and Hand Surgery, Pomeranian Medical University, Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University, Szczecin
References
  • Berman KS, Rothkopf DM, Schuffelbarger JV, et al.: Internal fixation of phalangeal fractures using titanium miniplates. Ann Plast Surg 1999; 42: 408-10.
  • Żyluk A, Budzyński T: Leczenie złamań kości śródręcza i paliczków - przegląd piśmiennictwa. Chir Narz Ruchu Ortop Pol 2006; 71: 299-308.
  • Reyes FA, Latta LL: Conservative management of difficult phalangeal fractures. Clin Orth Rel Res 1987; 214: 23-30.
  • Braakman M, Oderwald EE, Haentjens MH: Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 1998; 29: 5-9.[Crossref]
  • Harding IJ, Parry D, Barrington RL: The use of a moulded metacarpal brace versus neighbor strapping for fractures of the little finger metacarpal neck. J Hand Surg 2001; 26B: 261-63.
  • Hudak PL, Amadio PC, Bombardier C: Upper Extremity Collaborative Group. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand). Am J Ind Med 1996; 29: 602-08.[Crossref]
  • Ford DJ, Ali MS, Steel WM: Fractures of the fifth metacarpal neck: is reduction or immobilization necessary? J Hand Surg 1989; 14B: 165-67.
  • Hansen JM, Hansen TB: The treatment of fractures of the ring and little metacarpal necks: a prospective randomized study of three different types of treatment. J Hand Surg 1998; 23B: 245-47.
  • Ford DJ, El-Hadidi S, Lunn PG, et al.: Fractures of the metacarpals: treatment by A.O. screw and plate fixation. J Hand Surg 1987; 12B: 34-37.
  • Klein DM, Belsole RJ: Percutaneous treatment of carpal, metacarpal and phalangeal injuries. Clin Orth Rel Res 2000; 375: 18-25.
  • Kelsch G, Ulrich C: Intramedullary K-wire fixation of metacarpal fractures. Arch Orthop Trauma Surg 2004; 124: 523-26.
  • Konradsen L, Nielsen P, Albrecht-Beste E: Functional treatment of metacarpal fractures. Acta Orth Scand 1990; 61: 531-34.
  • McMahon PJ, Woods DA, Burge PD: Initial treatment of closed metacarpal fractures. J Hand Surg 1994; 19B: 597-600.
  • Greene TL, Noellert RC, Belsole RJ, et al.: Composite wiring of metacarpal and phalangeal fractures. J Hand Surg 1989; 14A: 665-69.
  • Gropper PT, Bowen V: Cerclage wiring of metacarpal fractures. Clin Orth Rel Res 1984; 188: 203-07.
  • Liew KH, Chan BK, Low CO: Metacarpal and proximal phalangeal fractures - fixation with multiple intramedullary Kirschner wires. Hand Surg 2000; 5: 125-30.
  • Horton TC, Hatton M, Davis TR: A prospective, randomized controlled study of fixation of long oblique and spiral shaft fractures of the proximal phalanx: closed reduction and percutaneous Kirschner wiring versus open reduction and lag screw fixation. J Hand Surg 2003; 28B: 5-9.
  • Ouellette EA, Freeland AE: Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orth Rel Res 1996; 327: 36-46.
  • Page SM, Stern BJ: Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg 1998; 23A: 287-83.
  • Pun WK, Chow SP, So IC, et al.: Unstable phalangeal fractures: treatment by A.O. screw and plate fixation. J Hand Surg 199; 16A: 113-17.
  • Kuokkanen HO, Mulari-Keranen SK, Niskanen RO, et al.: Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Hand Surg 1999; 33: 315-17.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-009-0033-x
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