Operative Treatment in Fractures of the Metacarpal and Phalanx in the Crushing Injury

Kim, Hyoung Min; Kim, Youn Soo; Park, Choong Seo; Eun, Seung Pyo

Abstract

Fractures of the metacarpal and phalanx of the hand are common occurances and bony union usually occurs without difficulties. If complication of the metacarpal and phalangeal fracture of the hand occurred, it causes significant functional deficit. The authors have reviewed 92 patients, 121 cases of metacarpal and palangeal fracture of the crushed hand which were treated with internal fixation with/without open reduction in the deparment of orthopaedic surgery in Holy Family Hospital from Jan. 1985 to Dec. 1989. The authors obtained the following results ; 1. The incidence of nonunion and delayed union was 12.4% (15/121 cases). 2. The criteriae of nonunion and delayed union are progressive angulation at fracture site after removal of implant, lack of bony union evidence in the radiography more than 12 weeks after injury, tenderness and pain on motion at fracture site and gross pseudomotion. 3. Nonunion and delayed union occurred more commonly in phalangeal fractures, shaft fractures, severely traumatized fractures (open fractures, marked displaced fractures, comminuted fractures and fractures had associated injuries in the same hand) and under-reduced fractures after internal fixation. 4. Mean TAM (total active motion) range at last follow up was 94.5°in thumb and 186.6°in finger and that of nonunion and delayed union cases was 89°in thumb and 153.5°in finger.