gms | German Medical Science

Objectives/Interrogation: Operative treatment of hand fractures is reserved for unstable, irreducible, comminuted, intraarticular, and open fractures. The aim of this study was to evaluate the outcome of hand fractures treated with titanium, low profile plate and screws.

Methods: 90 patients with 114 hand fractures were treated with titanium mini plates and screws. 46 phalangeal and 68 metacarpal fractures were included. Mean age of the patients was 36 years (from 11 to 75). The dominant hand was injured in 50 patients (55%).

114 fractures involved 113 rays. 32 were open, 27 were intra-articular and 12 were both open and intra-articular. 23 fractures involved combined injuries with damage to tendons or neurovascular bundles.

Fractures were fixed after a mean of 2.9 days (range, 0-28) from injury. Regional anaesthesia was utilized in 85 patients and general anaesthesia in 5 patients. Combined plates and screws were used in 85 fractures, while only screws were used in the remaining 29 fractures. Fixation with screws was selected for condylar or intra-articular fractures, and for long oblique or spiral diaphyseal fractures.

Results and Conclusions: Mean follow-up was 39 months (from 30 to 57). Apart from one case, all fractures were successfully fixed. Grip strength was measured as high as 89% compared to the uninjured hand even in patients of intra-articular fractures. Open intra-articular fractures had the worst outcome in grip strength (67% of the contralateral hand). Regarding tip pinch, open intra-articular fractures had the least favorable outcome (68% of the contralateral pinch strength). DASH score was 8.7 in the intra-articular group and reached 15.6 in the open intra-articular group. Finally, pain measured with the Visual Analog Scale reached a maximum of 2.3 in all groups, except for open intra-articular fracture, which demonstrated a mean of 3.2. There was no statistically significant difference in grip strength (p= 0.25) or Total Active Motion (p= 0.849) between extra and intra-articular fractures. TAM and grip strength were statistically different between open and closed fractures (p= 0.001 and p= 0.013 respectively).

Low profile plates and screws can be used successfully to establish union and restore alignment of the hand skeleton while achieving satisfactory clinical outcome. Factors that influenced the final outcome included the severity of the initial injury and not the anatomic location (intra or extra-articular, metacarpal or phalangeal) of the fracture.