Management of fractures of metacarpals and phalanges and associated risk factors for delayed healing.

OBJECTIVE: To assess the type of fractures of metacarpal and phalanges of hand and their treatment plan, investigate the risk factors (infection, segmental bone loss, associated soft tissue injuries) for the development of delayed union of the fracture site. METHODS: This descriptive study was conducted at Plastic, Reconstructive and Hand Surgery Unit, Liaquat National Hospital, Karachi. It included 120 patients who attended Accident and Emergency Department with metacarpals and phalanges fractures during August 2005 to January 2006. Severely traumatized patients or patients with amputated hand or digits were excluded. The data was collected through hand injury chart which fulfilled the inclusion criteria. Data was analyzed by SPSS version-10. RESULTS: In 120 patients with 226 fractures of the metacarpals and phalanges male to female ratio was 5:1. Metacarpal fractures were 38.9% and the fracture of the phalanges was 61.1%. Oblique fractures were 47%, transverse 28.3%, comminuted 13.27%, spiral 8.9%, and avulsion fractures were 2.6%. Surgically treated patients were 78.3% while 21.7% were managed conservatively. For fixation of fractures Kirschner wires (K-wire) were used in 89.36% cases, miniplates and lag screw in 4.25% and external fixators in 2.1%. Infection was found in 5 (2.2%) of the total fractures, out of these 2/5 (40%) had developed non union of the fracture site. Bony defect was found in 30 (13.3%) of the total fractures, of these 4/30 (13.3%) developed non union. Associated soft tissue injury was found in 130 (57.5%) and of these 11/130 (8.46%) developed non union. CONCLUSION: Most of the fractures of the metacarpals and phalanges were oblique in configuration, followed by transverse fractures. More then 75% of these fractures where treated surgically. K-wiring was the most commonly performed procedure. Infection, segmental bone loss and associated soft tissue injuries were predisposed to non union in small percentage of cases.

Kirschner wire pin tract infection rates between percutaneous and buried wires in treating metacarpal and phalangeal fractures.

OBJECTIVE: To compare pin tract infection rate between percutaneous and buried placement of Kirschner (K-) wiring for hand fractures. STUDY DESIGN: Quasi--experimental study. PLACE AND DURATION: Plastic, Reconstructive, Hand and Burn Surgery Unit, Liaquat National Hospital, Karachi, from September 2005--February 2006. PATIENTS AND METHODS: Patients with fractures of metacarpals and phalanges of hand were selected by non-probability purposive method. Assessment of pin tract infection by clinical examination and pin tract scoring was done by modification of Oppenheim classification. Statistical analysis was done using Chi-square test. RESULTS: Ten out of 55 percutaneous and 2 out of 45 buried wires were infected. The difference in infection rates of two groups was statistically significant at p<0.05. Three percutaneous, but not buried Kirschner wires, had to be removed before 4 weeks because of failure to respond to local wound care and oral antibiotics. CONCLUSION: Percutaneous K- wires had significantly greater infection rate than wires which were buried deep to the skin.

Gender difference in metacarpal descent of fifth metacarpal.

OBJECTIVE: To determine the difference in metacarpal descent of fifth metacarpal between men and women. STUDY DESIGN: Descriptive study. PLACE AND DURATION: The outpatient department of plastic, reconstructive and hand surgery at Liaquat National Hospital, Karachi, from August 2005 to February 2006. PATIENTS AND METHODS: Skyline of the 2nd and 3rd metacarpals were used as reference line, from which the descent of the 5th metacarpal head was measured. The position of 5th metacarpal head was documented as angle X. Metacarpal descent was defined as the difference between angle "X" in relaxed and clenched fist position. The relaxed position was standardized by placing the forearm, wrist and palm on a shaped woodblock such that the wrist would be held in 25 - 30 degree in extension by a triangular spur, supported the 3rd metacarpal only. It was ensured that the movement of 4th and 5th metacarpals were not impaired. Analysis of variance was performed to compare the significance of means between genders at p<0.05 level of significance. RESULTS: Metacarpal descent of the 5th metacarpal of both hands was significantly greater for women, with a mean of 7 degree as compared with a mean of 4 degree for the men. This decrease in angle "X" was significant for the right 5th metacarpal relaxed and fist position and the fist position on the left. In contrast, women showed no significant differences between the various age groups for any of the variables tested. There was no relationship between metacarpal descent and hand dominance. CONCLUSION: Difference in metacarpal descent between men and women is significant and must be kept in mind when hand function is evaluated in both genders to assess the outcome of treatment and rehabilitation.