Management of intra-articular metacarpal and phalangeal fractures with external fixators

Abstract

Objective To investigate the clinical efficacy of external fixators in the treatment of intra-articular fractures of the metacarpal and phalangeal bones. Methods From February 2012 to September 2017, a total of 30 patients with intra-articular metacarpal or phalangeal fractures (30 fingers) were treated by external fixators (combined with limited internal fixation using Kirschner wire in some cases). X-ray films were taken at the first day, the first week and the second week after operation. If necessary, the external fixator could be adjusted again according to the results of X-ray films to achieve better reduction of the fractures. Results The follow-up period ranged from 6 to 72 months with an average of 22 months. Follow-up lost occurred in 1 case after removal of the external fixator. The average clinical healing time of fracture was 7 weeks. After operation, 1 case had loosening of fixation pin, 1 case had severe pain, 4 cases had joint stiffness, 1 case had malunion of fracture, 1 case had damage of articular surface and obviously narrow joint space, 4 cases had poor tolerance to cold stimulation. In the last follow-up, total active motion (TAM) was used to evaluate the function. The results were rated as excellent in 15 cases, good in 5 cases, fair in 7 cases and poor in 2 cases, with the excellent and good rate being 69%. The mean DASH score was 4.2 and the average postoperative 6 weeks could return to work and daily life. Conclusion External fixator (combined with limited internal fixation using Kirschner wire in some cases) is an effective and safe method for the treatment of intra-articular fractures of the metacarpal and phalangeal bones. Key words: Metacarpal bones; Finger phalanges; Intra-articular fracture; External fixator