Arch Hand Microsurg.  2018 Dec;23(4):230-238. 10.12790/ahm.2018.23.4.230.

Comparative Analysis of Fracture Angulation between Parallel Pinning and Plate Fixation Techniques in the Management of 5th Metacarpal Fractures

• Lee M
• Shin H
• Choi H
• Kim J
• Shin D

• KMID: 2427388
• DOI: http://doi.org/10.12790/ahm.2018.23.4.230

Abstract

PURPOSE
Metacarpal fractures are common injuries of the hand. They are treated using closed reduction (CR) or open reduction (OR) techniques. The management strategy depends on fracture site characteristic and fixation methods. In this study, we evaluated pre- and postoperative fracture angulation, when metacarpal fractures bad been treated using two different techniques: CR with parallel transverse pinning and OR with plate fixation.
METHODS
Forty-six patients undergoing anatomic reduction to treat extra-articular metacarpal fractures were recruited. They were included in one of two therapeutic groups: Group 1, CR with parallel transverse pinning (n=21); Group 2, OR with plate fixation (n=25). Fracture angulation values have been measured on pre- and postoperative radiologic images. Values were compared between pre- and postoperative states, and between corresponding measurements of each group.
RESULTS
All extra-articular metacarpal fractures were successfully treated without wound related complications or the limit of joint motion. Both groups demonstrated adequate reduction at immediate postoperative period (postoperative angulation of group 1, 20°±7°; group 2, 19°±5°). During the observation at follow-up period, Group 1 exhibited slight recurrence (follow-up angulation of group 1, 24°±10°). Nonetheless, Group 2 showed adequate reduction state in both immediate postoperative and long-term follow-up periods (follow-up angulation of group 2, 18°±6°).
CONCLUSION
Extra-articular metacarpal fractures were successfully restored without functional complications. CR with parallel transverse pinning method exhibited recurrence after pin removal, which necessitates cautious postoperative exercise and monitoring.

Keyword

Metacarpal bones; Fracture; Angulation; Closed fracture reduction; Open fracture reduction

MeSH Terms

Follow-Up Studies
Hand
Humans
Joints
Metacarpal Bones
Methods
Postoperative Period
Recurrence
Wounds and Injuries

Figure

• 

  Fig. 1 Fracture angulation was analysed using uninjured contralateral metacarpal (A), injured metacarpal preoperative (B), postoperative (C), and long term follow-up (D) X-ray images. Measurements have been undergone on oblique views of hand X-ray. Measured values were utilized for intergroup comparison, and besides difference of angles were figured out (i.e., b-a, c-a, and d-a) to avoid normal angulation between metacarpal head and shaft.

• 

  Fig. 2 Case 1. (A) A 28-year-old male patient was injured on the right 5th metacarpal bone, angulation 48°. (B) The metacarpal neck fracture was reduced using closed reduction and parallel transverse pinning method, showing 20° angulation. (C) However, heavy functional activities have led to slight recurrence (angulation 23°) at 4 week postoperative period.

• 

  Fig. 3 Case 2. (A) A 30-year-old male patient was injured on the right 5th metacarpal bone, angulation 39°. (B) The metacarpal shaft fracture was reduced using open reduction and internal plate fixation method, showing 17° angulation. (C) Active exercise was followed by implant removal at 30 weeks postoperatively. The metacarpal shaft presented stability with maintenance of 15° angulation.

• 

  Fig. 4 Fracture angles were analysed based on the difference between angulation of injured and uninjured metacarpals. Group 1 and 2 showed adequate reduction postoperatively. However, Group 1 (closed reduction and percutaneous parallel pinning) demonstrated slight recurrence in terms of angulation (p<0.05). Nonetheless, Group 2 (open reduction and plate internal fixation) presented consistent maintenance of reduction state. PreOp: Preoperation, PostOp: Postoperation.

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