gms | German Medical Science

Objectives/Interrogation: Metacarpal and phalangeal fractures account for 41% of all below-elbow fractures. Despite most of them can be managed successfully conservatively, unstable fractures often need surgical treatment. We sought to compare the three different techniques most used in extra-articular metacarpal and phalanx fractures: plate-screw, KW and retrograde intramedullary screw (RIS). We aimed to determine whether retrograde intramedullary screw provides better clinical outcomes than plate-screw or KW fixation.

Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017. Only patients with displaced short oblique or transverse extraarticular metacarpal and phalangeal fractures were included. Patients were classified into three groups depending on the treatment received: plate-screw, KW and RIS. The duration of each procedure was collected. Clinical assessments included measuring total active motion, grip strength, and evaluation of plain x-ray until healing. Quick-DASH had been performed in all the patients. The data was analyzed by model analysis of variance (ANOVA) or Kurskall-Wallis rank test.

Results and Conclusions: A total of 253 fractures in 230 patients were included, 202 metacarpal and 51 phalangeal fractures. One hundred thirty-five fractures underwent plate-screw fixation (53.3%), 53 KW fixation (20.9%), and 65 RIS fixation (25.6%). Mean surgery time was significantly shorter in KW (20 min [11-36]) and RIS (25min [17-38]) groups, compared to plate-screw group (32min [16-48]) (p<0.05). Loss of reduction occurred in 6 patients in KW group, 2 in plate-screw group and 3 in RIS group. A total of 38 patients of KW group, 33 patients of PS group and 2 patients of RIS required hardware removal. No differences between the three groups were observed when evaluating mean grip strength, total active motion, Quick Dash and mean time to radiological union. Mean return to work time was significantly lower in the plate-screw (7.8 weeks, [3-6]) and RIS (8.3 weeks, [4-24] groups when comparing to KW group (9.2 weeks, [5-20] (p<0.05).

Surgical treatment should be individualized in patients with unstable metacarpal and phalangeal fractures. RIS has shown lower surgery duration and time to return to work when compared to plate-screw and KW, respectively, and lower hardware removal compared to both. Prospective randomized study should be performed to better define the advantages of retrograde screw technique.