Outcome Analysis of Metacarpal and Phalangeal Fixation Techniques at Bellevue Hospital
Derek D. Reformat, MD, Gabriela Nores-Garcia, MD, Gretl Lam, BA, Daniel Cuzzone, MD, J. Brad Hill, MD, Horatiu Muresan, MD, Vishal Thanik, MD.
New York University Langone Medical Center, New York, NY, USA.
Phalangeal fractures represent a significant portion of upper extremity injuries but are not well studied as a single entity. The purpose of this study is to define our approach at a Level 1 trauma center and determine whether plating or lag screws (rigid fixation) for fractures of the phalanges or metacarpals has superior functional outcomes compared to Kirschner wire fixation.
The cases of all hand fractures managed surgically at Bellevue Hospital during 2012 and 2013 were reviewed. Demographics, type of fixation, length of operation, period of immobilization, range of motion, and time to return to work, and complications including re-operation were noted and comparisons were assessed for significance using t-tests (p<0.05 considered significant).
193 fractures (158 patients) fractures were treated and followed for an average of 113 days. Rigid fixation was used for 17 (19%) of 91 metacarpal fractures and 5 (5%) of 102 phalangeal fractures. Operative times were significantly shorter (59m vs. 135m, 84m vs. 149m) and period of immobilization longer (37d vs 15d, 34d vs. 18d) when K wires were used for metacarpal and phalangeal fractures, respectively (p>0.05). Total active motion (TAM) and return to work were similar regardless of type of intervention in both fracture types. No patients treated with rigid fixation required re-operation.
To our best knowledge, this is the first review to study phalangeal fractures concurrently but also separately from metacarpal fractures. Despite shorter periods of immobilization, rigid fixation does not lead to improved TAM or time to return to work.
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