Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb

Abstract

The aim of this study was to investigate the radiological and functional results of anatomical reduction and stable fixation followed by an early rehabilitation programme in the treatment of fractures of the base of the thumb metacarpal. Sixteen consecutive patients (11 men and five women; mean age: 36.4 years) with intra-articular fractures of the thumb metacarpal base were treated with plate and/or screw fixation between April 2002 and March 2011 at our department. Patients were followed-up for an average period of 15.62 months. Bony healing was achieved in all cases and all patients were able to return to pre-trauma activity levels 12 weeks following surgery. Open reduction with stable internal fixation and an early active rehabilitation programme appears to be an efficient method in the treatment of trapeziometacarpal joint fractures with satisfactory functional and radiological results.

Early active motion after rigid internal fixation of unstable extra-articular fractures of the proximal phalanx

“…We believe that our better outcomes are related to the use of an early active rehabilitation without immobilization. We have achieved comparable results in a previous study, in which the same early postoperative rehabilitation principle was applied for the fractures of the thumb metacarpal base (Uludag et al, 2015). These results seem to support the principles of early motion rehabilitation following proximal phalangeal fractures developed by others (Cannon, 2003;Feehan, 2003;Feehan and Bassett, 2004;Glasgow et al, 2003;Uludag, et al, 2015).…”

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

“…With the development of arthroscopy, some doctors prefer arthroscopic reduction and internal fixation [17,18]. There are various methods of fixation: pins [3][4][5][6]19], screws [17,20], plates [9,21], tension bands [22,23], and external fixator [24]. Most researchers believed that anatomic congruity is more important than fracture fixation technique for longterm success.…”

“…None of them had bony deformities or lesions checked by fluoroscopy. The Bennett's fractures were created using an open Wagner approach [9]. The thenar muscles were stripped extraperiosteally and reflected from the volar aspect of the trapezium and metacarpal bone.…”

Fractures and dislocation of the base of the thumb metacarpal

“…There are various reported means of fixation: pins (Bennani et al, 2012;Culp and Johnson, 2010;Greeven et al, 2012;Lutz et al, 2003); screws (Leclère et al, 2012;Meyer et al, 2003;Strömberg, 1977;Tourne et al, 1988); or plates (Pavic and Malović, 2013;Uludag et al, 2013).…”

“…Osteosynthesis of Bennett’s fracture dislocations can be performed by percutaneous fixation (Bennani et al, 2012; Greeven et al, 2012), open surgery (Leclère et al, 2012; Lutz et al, 2003) or under arthroscopy (Culp and Johnson, 2010; Zemirline et al, 2014). There are various reported means of fixation: pins (Bennani et al, 2012; Culp and Johnson, 2010; Greeven et al, 2012; Lutz et al, 2003); screws (Leclère et al, 2012; Meyer et al, 2003; Strömberg, 1977; Tourne et al, 1988); or plates (Pavic and Malović, 2013; Uludag et al, 2013).…”