Till date, the outcomes for these two treatment modalities have been systematically synthesized by one meta-analysis. Due to variability in the sample population, surgical experience, and operational definitions of the outcomes considered, recent attempts to compare plate and pin fixation for metacarpal fractures have yielded mixed and equivocal results. Moreover, newer plates are smaller in size, allowing periosteal closure and potentially reducing adhesions compared to previously built plates. The use of plates and screws, on the other hand, offers direct fracture reduction and enables an early range of motion. In terms of limited surgical exposure and feasibility of administration, pinning has an advantage. The two surgical modalities that have recently emerged for the management of metacarpal fractures that cannot be treated by casting alone are closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screw. Given that there is a large difference in the fracture patterns and the underlying mechanism, it is difficult to perform controlled clinical trials. Ĭurrent metacarpal fracture management relies on data from individual studies that concentrate on a standalone modality. The main goal of surgical management is to restore the bony shape, to enhance early mobilization, and to avoid functional impairment. Clinical evidence shows that the neck of the metacarpal, the fifth metacarpal in particular, is the most affected. Either accidental falls or direct impact trauma is responsible for most of these fractures. Metacarpal fractures often comprise a large proportion of all hand fractures and fractures below the elbow, particularly in industrialized environments such as the USA. The choice of modality should be made based on the skills and preference of the surgeon and availability of resources.Įmergency departments usually have a high inflow of patients with hand injuries, and metacarpal fractures represent around half (40%) of these hand injuries. No significant long-term differences were noted in the functional outcomes suggesting that both these techniques are comparable. For all the outcomes, the quality of pooled evidence was judged as low to very low. No difference was seen in the risk of complications between the two interventions (RR 0.93 95% CI, 0.57, 1.53 I 2 = 31.2%). The pooled estimates did not suggest any significant differences in the disabilities of the arm, shoulder, and hand (DASH) score, range of movement (ROM) of the metacarpophalangeal joint ( o), and grip strength among the two intervention modalities. ResultsĪ total of 9 studies were included. GRADE assessment was done to assess the quality of pooled evidence. Statistical analysis was done using STATA version 13.0. Randomized controlled trials, quasi-experimental studies, prospective comparative non-randomized studies, and even studies reporting findings from retrospective chart review were eligible to be included. MethodsĬomprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. With newer studies being published, an effort to update the earlier meta-analysis is necessary. These are intra-articular fractures that result from axial loading or direct trauma collateral ligament avulsion fractures are caused by forced deviation of the flexed metacarpophalangeal joint (MCPJ).The differences in the clinical and functional outcomes of closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screws have been systematically synthesized by one meta-analysis. These are usually a result of axial loading or direct trauma (clenched fist and solid surface) torsional force may also result in this type of injury Metacarpal base fractures and dislocation of the CMC joint They are a result of direct or indirect trauma with the nature and direction of the force being directly related to the type of injury. Fractures of the 5 th metacarpal make up 25% of all metacarpal fractures (which equates to 10% of all hand fractures) ref. The lifetime incidence of a metacarpal fracture is 2.5% ref. Specific names are given to fractures of the fifth metacarpal:įracture dislocation of the base of the 5 th metacarpal: reverse Bennett fracture dislocationįracture of 5 th metacarpal neck: Boxer fracture Gamekeeper thumb (not always includes a fracture) Specific names are given to fractures of the base of the first metacarpal (see: fractures of the thumb):
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