| Metacarpal and phalangeal fractures are the most common injuries of the upper extremity.The incidence of metacarpal and pahlangeal fracture peak exists in the age between 10 and 40 years.Metacarpal and phalangeal fractures are more common in males,and are mostly caused by athletic injuries and physical labor injuries.The anatomy structure is complicated and the function is meticulous.Injuries to the densely compacted structures of the hand often involve damage to multiple tissues.It is a mistake to consider fracture healing rather than soft tissue healing,because it requires functional integrity of both tissues to achieve the successful outcomes.Most metacarpal and phalangeal fractures can be treated with nonsurgical stabilization.However,some of them must be are treated with open reduction and internal fixation in some cases of an open fracture,high-energy injuries with soft tissue stripping,and multiple fractures.This procedure allows anatomic reduction and early motion.Although many implants and techniques exist for this purpose,no standard method exists still.Open reduction and internal fixation of hand fractures has become more popular over the past 3 decades because of improved implant materials and designs,surgical technique,and radiograph availability and resolution.Besides,public demand for anatomic fracture restoration is also an important consideration.Open reduction and internal fixation of hand fractures presents a unique challenge to the hand surgeon because of the difficulty in managing small fragments without blood supply.Open reduction and fixation may also increase the risks of tendon or joint adhesions adjacent to the fracture.In this article,we evaluate clinical results for open reduction and internal fixation of unstable periarticular fractures of the metacarpal and phalangeal bones using the AO miniature plate system.Furthermore,we usedouble-row plate,locking plate and normal straight plate to fix the domestic pig second metacarpal fracture and compare the mechanical characteristics of these fixation implants.In the reviews,we focused on the choice of implants and postoperative complications of metacarpal and phalangeal fractures and reviewed the literature on the treatment of malunion of the hand fractures.Part 1 Application of AO mini plate and screw in the treatment of metacarpophalangeal joint periarticular fracturesObjective: The purpose of this study was to evaluate clinical results for open reduction and internal fixation of unstable periarticular fractures of the metacarpal and phalangeal bones using the AO miniature plate system.Method: We retrospectively reviewed 265 patients(172 males and 93females)with 302 metacarpal and/or phalangeal fractures.The mean age was of 32.5 years(range: 17-59 years)old.We determined the standard internal fixation treatment method based on the AO/ASIF Comprehensive Classification of Fractures.We used a "T" shape,mesh plate or a condylar plate for A2,A3,C1,C2 type fractures.Screws alone were used for B type fractures.Active and passive flexion and extension exercises began 3 days postoperative within the limits of the patient pain tolerance.The total active motion(TAM)score were used to evaluate all the patients.Results: The patients were followed up for 4 to 8 months,with an average of 4.6 months.X ray showed the fracture line disappeared at 6.5 to 12 weeks,averaging 8.2 weeks postoperatively.The functional results of hands according to TAM ratings criteria were excellent in 113 patients,good in 136 cases,and poor in 53 cases.The excellence and good rate was 82.5%.Conclusion: Metacarpal and phalangeal fractures have complex anatomic structures.Complications after these injuries include joint stiffness,posttraumatic arthritis and etc.The traditional conservative treatment method is less effective.AO miniplate and screws system could provid rigid and stable fixation and is a preferred approach in treatment of metacarpal and phalange periarticular fractures.Part 2 Biomechanical Study of Micro Double-row Titanium Fixation for Metacarpal FracturePurpose: We sought to compare the biomechanical strength of 3 different plate fixation methods plating for unstable metacarpal fractures.Methods: We prepared the domestic pigs’ second metacarpal fracture mode in the preparatory phase.Then we use T plate,normal straight plate,locking plate and double-row plate to fix the fracture.Afterward,apex volar,dorsal,transversal and torsion max load were used to test until to failure in each group.Results of these plates mechanical characteristics were compared and analyzed.Results: All constructs broke through the bone.No plate failure or screw pullout was observed.The mechanical characteristics of T plate,normal straight plate and locking plate are similar.And the 6 hole double-row plate had the highest load strength to failure.Conclusions: Double-row plates with small profile and converging screws provide adequate or superior strength of fixation,compared with other standard plate constructs.Part 3 Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Meta-carpal and Phalangeal FracturesObjective: This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw(ATLPS)and anterograde intramedullary(AIM)fixation for treating unstable metacarpal and phalangeal fractures.Methods: Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013.Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement,fracture complexity,and surgeon’s experience and were then treated accordingly.Relevant demographic,clinical and preoperative clinical data were collected and analyzed.Clinical examination and radiograph evaluation were performed 1 week and 1,3,and 6 months postoperatively.Outcome measures were visual analog scale(VAS)scores for pain,total range of motion(ROM)of the injured digit,Quick Disabilities of the Arm,Shoulder,and Hand scores(Quick-DASH)and grip strength(percentage of the contralateral corresponding digit).Results: From July 2013 to September 2014,76 patients were treated by AIM and 71 by ATLPS.Age,sex,time from injury to operation,dominant hand,injury mechanism,fracture location,fracture type and participant occupation were similar in both groups(P>0.05).Operations were all performed well and followed by uneventful postoperative functional recoveries.At3-month follow-up,all clinical outcomes were significantly better in the AIM than ATLPS group(P<0.05)except for VAS pain scores.However,at 6-month follow-up,the differences were no longer significant,indicating similar results for both types of fixation.Patients in the AIM group developed significantly more complications(P=0.037).Sick leave was significantly longer in the AIM group(P=0.02).Conclusions: AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early,but not the later,postoperative period;the latter is associated with significantly more complications.Patients treated by ATLPS require shorter sick leave,which is of particular benefit to workers with specialized manual skills. |
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