J Korean Soc Surg Hand.  2017 Sep;22(3):189-195. 10.12790/jkssh.2017.22.3.189.

Surgical Treatment of Metacarpal and Phalangeal Fracture with Rotational Malalignment

• Lee S
• Lee S
• Lee JK
• Sim Y
• Choi DS
• Han SH

• KMID: 2391216
• DOI: http://doi.org/10.12790/jkssh.2017.22.3.189

Abstract

PURPOSE
Hand fractures can be treated conservatively in many cases, but rotation malalignment is one of the important indications for surgical treatment because of dysfunction. We performed open reduction and internal fixation in these malalignment fractures and report clinical and radiological results.
METHODS
This study included 28 patients (18 male, 10 female) who had metacarpal and phalangeal fractures with rotational malalignment of finger on initial examination. Patients with combined injuries including open soft tissue damage or multiple fractures were excluded. Mean age was 36.1 years and average follow-up period was 14.6 months. Perioperative extent of rotation and correction during the follow-up, union on the radiographs, Range of motion, disability of the arm, shoulder and hand (DASH) score, and pinch power at the last follow-up were evaluated.
RESULTS
Average corrected angulation of rotation was 11.9° and no patient showed scissoring appearance of fingers at the last follow-up. All patients showed solid bony union on the radiographs during the follow-up. The average of total active motion of the injured fingers were average 254°, average DASH score was 3.2 and average pinch power was 3.0 kg at the last follow-up.
CONCLUSION
Clinical and radiologically satisfactory results were obtained in all patients. Care should be taken not to overlook the rotational misalignment after fracture of the hand, and surgical treatment should be considered to ensure correct reduction and fixation.

Keyword

Fractures; Metacarpal bones; Finger phalanges; Open fracture reduction

MeSH Terms

Arm
Finger Phalanges
Fingers
Follow-Up Studies
Fractures, Multiple
Hand
Humans
Male
Metacarpal Bones
Range of Motion, Articular
Shoulder

Figure

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  Fig. 1 Rotational angle measurement of right 4th middle phalanx fractured hand.

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  Fig. 2 Radiologic measurement methods of anteropaterior angulation (A), saggital angulation (B), and fracture bone height (C).

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  Fig. 3 A 38-year-old woman was injured from traction injury resulting in minimally displaced spiral fracture on left 4th finger proximal phalanx. Initial anteroposterior and oblique plan radiographs (A, B). Physical examination in outpatient clinic presented 4th finger overlapping on 4th finger (C). Intraoperative clinical photo of open reduction and internal fixation (D). Correction of rotational alignment after operation (D). Postoperative AP plain radiographs (E) showed anatomic reduction and proper fixation with two lag screws.

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  Fig. 4 Repeated measures analysis of variance result. Serial measurement represented preoperative and postoperative passive angle measurement under anesthesia and final follow up active angle measurement between convergent and divergent group.

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  Fig. 5 Paired T-test between immediate postoperative fractured hand angle and unaffected healthy control angle.

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