Transverse Fracture of Metacarpal and Proximal Phalangeal Shaft Fractures of the Hand Treated by Theta Fixation

Abstract

BACKGROUNDMany implants and techniques are used for the treatment of transverse metacarpal and phalangeal fractures with varying grades of stability. Simple Kirschner (k) wiring does not provide adequate stability to allow early mobilisation of fingers. Lister described a combination of coronal interosseous wire and oblique K wire technique for phalangeal and metacarpal fracture fixation with a stable construct that allowed early mobilisation. Due to the fancied resemblance of this construct to the Greek alphabet theta, we have referred to this as theta fixation. MATERIALS AND METHODSTwenty-one patients with transverse metacarpal and proximal phalangeal shaft fractures were treated with theta fixation between January and June 2015. Outcome was analysed in terms of stability, early mobilisation, fracture healing and function of the hand. They were graded according to the Belsky score. RESULTSA 90% patients were graded excellent and 10% good with one having fair or poor results. All fractures allowed the mobilisation at a mean of 2.9 days and all healed at an average of 6.1 weeks. No loss of stability was seen on followup x-rays. All patients returned to their old profession. CONCLUSIONThe theta fixation technique is a safe, simple and effective method for transverse metacarpal and proximal phalangeal fractures with results comparable to other techniques. This method gives superior fracture stability to allow early mobilisation of joints and thus early return of function. It is also a cost effective way of management for the developing world.