Functional evaluation of various surgical modalities in treatment of hand fractures

Abstract

Background: "Hand fractures can be complicated by deformity from no treatment, stiffness from over treatment, both deformity and stiffness from poor treatment." -Swanson. Fracture of metacarpal bone of the hand constituting between 14-28% of all visit to hospital following trauma by various means like assault, road traffic accidents, industrial accidents, agriculture accidents etc. Fracture of the bones of hand are among the commonest fracture in humans, but their management varies widely in the different regions of world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Among the spectrum of hand and wrist injuries, fractures of the wrist rank first in terms of frequency and morbidity, with an estimated incidence of 400 fractures per 100,000 inhabitants per year 3 . 3 Fracture healing in the hand is not an isolated goal; rather the functional result is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires, bicondylar plates and screws as compared to conservative treatment. Material and Method:The sample size of the study was 28 patient in 12 patient in k-wire group, 8 patient in jess group and 8 in plate group. The functional outcome was assessed by calculating Total active range of motion (TAM) as suggested by the American Society of Surgery of Hand. At every follow up TAM (total active range of motion) will be calculate as follows TAM= (Active flexion at MCP+PIP+DIP)-Extension deficit at MCP, PIP, DIP. Recovery was calculated as percent regained in motion compared to normal range of digital motion (260 degree). Result: Fracture healing in the hand is not an isolated goal; rather the functional result is paramount importance. JESS, Plating and K-wire comprised of 8, 8 and 12 subjects respectively. Mean age (in years) of the subjects in JESS group was 41.75±21.93 while the mean age of the subjects in plating and K-wire group was 39.12±20.18 and 43.83±21.84 respectively. 14.35, 21.4% and 17.9% of the subjects in JESS, Plating and K-wire group respectively were injured due to fall from height. Road traffic as mode of injury was reported in 14.3%, 7.1% and 25% of the subjects in JESS, Plating and K-wire group respectively. Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results.