A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures

Background: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at...

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Bibliographic Details
Published in:	Hand (New York, N.Y.) Vol. 14; no. 1; pp. 27 - 33
Main Authors:	Dreyfuss, Daniel, Allon, Raviv, Izacson, Nufar, Hutt, Dan
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-01-2019
Subjects:	Adolescent Adult Bone Nails Bone Plates Bone Screws Disability Evaluation Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Fracture Healing Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Hand Strength Humans Male Metacarpal Bones - diagnostic imaging Metacarpal Bones - injuries Metacarpal Bones - surgery Middle Aged Range of Motion, Articular Rotation Surgery Young Adult metacarpal shaft locked plate Kirschner wire metacarpal fracture intramedullary pinning
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Summary:	Background: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least 1 year after injury. All fractures were fixated by pinning between years 2013 and 2015 and by locking plates and screws between 2016 and 2017. Evaluation included range of motion measurements for all fingers compared with the contralateral hand; comparison of grip strength; finger alignment and rotation; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiographic measurements of fracture reduction and healing. Results: Thirty patients with 39 fractured metacarpals treated by pinning were compared with 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on radiograph. Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion, and 14° total vs 10° extension, 19° flexion, and 29° total), grip strength (93% vs 83% of contralateral hand), rotational deformity (5 digits, 1° vs 15 digits, 6°), and DASH score (10.5 vs 15.6). Radiographic bone healing time (59 vs 50 days) and operative time (58 vs 41 minutes) were both significantly longer in fractures fixated by plates. Conclusions: Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally.
ISSN:	1558-9447 1558-9455
DOI:	10.1177/1558944718798854