Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Background: There is no consensus on the optimal operative treatment of metacarpal fractures as every technique is associated with advantages and shortcomings. Objective: This study aim to compare the clinical and functional outcome of treatment of unstable extra- articular metacarpal fracturesby closed reduction and K-wires versus open reduction and mini-plates fixation. Patients and methods: This study included30 patients( 23 males and 7 females)withan average age of 30 yearswho presented at Emergency Hospital of Kasr-ALAiny.Patients were allocated randomly into 2 groupsaccording to fixation methods; Group (A) 15 patients: were fixed with closed reduction and K-wires, Group (B) 15 patients: were fixed with mini-plates and screws. Thetimes of (operation, unionand the immobilization after surgery) were assessed. All the fractureswere evaluated both clinically using theAmerican Society for Surgery of the Hand (ASSH) (Total Active Motion (TAM), Total Active Flexion (TAF)) and the quick DASH scores, andradiologically using three views of the hand(antero-posterior, oblique, and lateral) at each visit. The follow up period ranged from 4 to 6 months with mean value 5 months. Results:Patients were classified according to their fracture pattern ; In group (A): 5 cases (33.3 %) were spiral/ oblique fracture , 9 were transverse (60.0%) and 1 was comminuted (6.7%) ; In group (B): 5 cases (33.3%%) were spiral/ oblique fracture and 8 cases (56.7%) were transverse and comminuted 2cases (13.3%). Group(A) ( K-wires group) operative time ranged from 20 minute to 60 minute with mean value 40.9 minutewhich was significantly less than group (B) (ORIF group ): Operative time ranged from 39 to 70 minute with mean value 51.8 minute ( p value : 0.02).Union time mean value was 10.2 weeks in k wire group and 10.00 weeks in ORIFgroup

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