FUNCTIONAL OUTCOME OF CLOSED METACARPAL FRACTURES TREATED WITH MINI FRAGMENT PLATES AND SCREWS - A PROSPECTIVE STUDY

Dr.J.MAHESWARAN; Dr.V.MOHANAKRISHNAN

Volume : VIII, Issue : VII, July - 2019

FUNCTIONAL OUTCOME OF CLOSED METACARPAL FRACTURES TREATED WITH MINI FRAGMENT PLATES AND SCREWS - A PROSPECTIVE STUDY

Dr. J. Maheswaran, Dr. V. Mohanakrishnan

Abstract :

Nowhere in the body are form and function more closely related than in the hand. Often these metacarpal fractures are treated as minor injuries causing major functional disability. In order to maintain hand function man�s most important tool, the treatment of choice in recent years has shifted from predominantly conservative measures to more surgical procedures. Unstable metacarpal fractures require internal fixation. Long term follow up depends upon fracture angulation & rotation .Rotation of the digit impairs– functional grip and can be a source of chronic pain. Metacarpal shortening affects interosseous function with a 10mm loss of length corresponding up to 55% muscle power loss.Hand function – affected by 1) Angulation of the fracture greater than 30 degrees , 2) Rotational deformity greater than 10 degrees , 3) Gross shortening of the metacarpal >5mm Many factors such as delicate handling of tissues, preservation of gliding planes for tendons, prevention of infection, early and appropriate physiotherapy other than accurate reduction and fixation affect recovery of good mobility.This study includes 20 cases all of whom were adults. Closed unstable metacarpal fractures were selected. The outcome was analysed with special emphasis on active movement of fingers at metacarpophalangeal and interphalangeal joints. 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 .Detailed clinical and radiological assessment of fracture, careful preoperative planning, meticulous dissection, precision in surgical technique (coverage of plate with soft tissue) and choosing the correct implant (low profile plate) are critical in achieving good results and minimising the complication .