gms | German Medical Science

Objectives/Interrogation: Although several treatment options have been reported for distal metacarpal fractures, no definitive superiority or inferiority among the various treatment options were identified to date. This study aimed at comparing the outcomes of treatments for distal metacarpal fractures, such as conservative treatment, K-wire cross pinning or intramedullary fixation, and plate fixation.

Methods: We evaluated 50 fingers of 48 patients with distal metacarpal fractures who were treated at our hospital between April 2009 and September 2018. We compared the outcomes of three representative treatment options for these fractures; conservative treatment, K-wire fixation, and plate fixation. We defined the active range of motion (AROM) of the metacarpal phalangeal (MCP) joint at the final follow-up as the primary outcome, as well as compared the degree of volar or lateral angulation of the distal part of the fractured fragment before surgery and at the last follow-up among the three cohorts.

Results: The sample sizes for conservative treatment, K-wire fixation, and plate fixation were 19, 20, and 11 fingers, respectively. Although these cohorts included 7 open fractures and 18 intraarticular fractures, their distribution ratio did not significantly differ depending on the treatment. The average MCP joint AROM after plate fixation was 59°, which was significantly lower than that after conservative treatment (78°) and K-wire fixation (77°). Three of 11 patients with plate fixation underwent plate removal and stereoarthrolysis. Although preoperative volar and lateral angulation did not differ depending on the treatment option, postoperative volar angulation after conservative treatment was significantly larger than that after other treatments.

Conclusions: We compared the three representative treatments in our study, and suggested characteristics associated with each. Although postoperative reduction in position after plate fixation was better than that after conservative treatment, our study identified a negative effect of plate fixation on postoperative MCP joint AROM. As functional outcome is far more important than radiographic reduction, the indications of plate fixation for distal metacarpal fractures should be limited and other treatment options should be chosen instead.