gms | German Medical Science

Objectives/Interrogation: The objective of present study is to review the surgical technique (different kind of mounting) in a group of 225 fractures of phalanxes and 285 fractures of metacarpals. The objective is to have an algorithm in kirschner wire positioning and mounting of ex-fix for each pattern of fracture. We also analyze, time of healing, the number of complication as non union, defect of rotation or residual stiffness.

Methods: We reviewed 410 frame metacarpals and phalangeal fracture operated between 2012 and 2017 in our unit (285 metacarpals and 225 phalanx). The mean age is 37 years (min 12 years max 75 years) with a 3/1 man-woman ratio; of these patients 213 metacarpal fractures and 166 phalanges fractures were treated in a closed manner by reduction and percutaneous synthesis with k-wires and positioning of Joshi external fixator, under scopic control.

K-wires were positioned parallel in case of 5th 4th and second metacarpal, in few cases a inter-fragmentary k-wire has been also positioned to effort more stability and permit early motion.

This technique is useful even in case of Bennet or Rolando fractures, it's important stabilise the first metacarpal bone to the second metacarpal bone and trapezium after the reduction of the fracture.

In case of P1 base fracture K-wires has been positioned crossed, fixing the fragment to the diaphysis, or parallel in case of diaphyseal fracture,

In case joint PIP fracture the JESS has been used as a distractor

In case of Bush fractures, the Jess has been used to avoid k-wire migration in Ishiguro technique.

The position of k-wires in case of third or forth finger fracture is with a 40 degrees inclination.

The EF was removed after a 40-days (min 35 max 45 days) from surgery; active mobilization was started the day after surgery treatment.

We evaluated, at 6 months follow up, in 200 pts ROM and eventual complications.

Results and Conclusions: The treatment of hand fractures using JESS resulted in an average radiographic healing time of 40 days, complete recovery of ROM in 75 days; we had greater rigidity in extension recovery in case of phalangeal fractures, no case of deep infection or superficial irritation occurred.

In case of multiple metacarpal fracture we observed there could be a delayed x ray healing and stiffness, we had in one head P2 fracture 1 mm mal-rotation but the patient was satisfied about functional result.

Use of JESS external fixator in case of hand trauma is a valid solution to treat fractures without performing open surgical access.