Operative Treatment of Metacarpal Shaft Fracture

Kim, Bum Soo; Cho, Sung Do; Cho, Yong Sun; Park, Tae Woo; Cheong, Hwa Chel; Hong, Soon Woo; Cho, Soo Hyun

Abstract

The goal of treatment of fractures of the metacarpals includes the restoration or preservation of hand function. To accomplish this goal, the physician must select a method that will offer the least soft tissue damage and accelerate the mobilization of the injured part as soon as the fracture stability permits. The majority of fractures of metacarpals can be effectively treated by nonoperative approach, but when several metacarpals are fractured, when there is open soft tissue trauma, and when there are displaced fractures that cannot be reduced or cannot maintain the reduction, internal fixation is indicated. The authors reviewed 117 cases of metacarpal shaft fractures on which the operative treatment was performed. Closed reduction and percutaneous Kirschner wire fixation were performed on the 62 cases, open reduction and Kirschner wire fixation were performed on the 12 cases, closed reduction and percutaneous screw fixation were performed on the 16 cases, and open reduction and plate and screw fixation were performed on the 27 cases. The patient was followed up for 36 months in average. The results were evaluated on the basis of total active motion of the fingers. The results were satisfactory in 92 percent of the cases in closed reduction and percutaneous Kirschner wire fixation cases, 75 percent in open reduction and Kirschner wire fixation cases, 85 percents in open reduction and plate and screw fixation cases, and all the cases of the patients in the closed reduction and percutaneous screw fixation cases. The closed reduction and percutaneous screw fixation provided relatively stable fixation and minimal soft tissue injury, so the injured hand could be mobilized soon after the operation, and consequentely the excellent outcome was accomplished. So the authors suggest that in selected cases, the closed reduction and percutaneous screw fixation can be used as one of the good treatment methods in the treatment of metacarpal fractures.