الفهرس | Only 14 pages are availabe for public view |
Abstract Phalangeal and metacarpal fractures either closed or open, are common injuries of the hand. These fractures can be treated conservatively or operatively depending on the nature of injuries, fracture pattern and the fracture stability. The principles of management involve restoration of articular congruity and fixation of the fracture with an internal or external fixation device. Early mobilization of the affected joint improves functional outcome. Conservative traditional treatments may not get optimal results, and many times result in some sequel such as collapse and stiffness. Mini plate and screw, k-wires either ante grade, retrograde or transverse, tension band and flexible inter medullary nails are common methods of internal fixation. Internal fixation by plates and screws required open wound, dissection and K- wire usually leads to incapability of early mobilization secondary to smaller size of bone fragments or less fastness in fixation dragged by local ligament. In highly comminuted fractures, intra-articular fractures and open fractures external fixation offers an effective treatment option in the management of these difficult fractures and a variety of external fixators are available for this purpose. It has advantages as it often simplifies surgery by being both quick and easy to apply as well as it allows fracture reduction to normal bony length via a rigid external support, reduces further damage to the delicate soft tissues and bone. Summary 174 In addition, external fixation allows wound care and enables exercise of the finger joints at an early stage. It avoids internal dissection, yet provides fracture stability and easier soft tissue access and management. This prospective study was undertaken to assess the use of external fixator in the management of metacarpal and phalangeal fractures. In this study 20 patients had been managed in El-Menofia University Hospital and El-Menshawy Hospital between April 2010 and January 2014. And all the patients were followed up for at least 6 months fractures The mean age of the patients was 36.7 (range: 21-62) years. All patients were males (100 %). There were 10 (50%) open fractures and 10 (50%) closed fractures. There were 13 (65%) extra-articular and 7 (35%) intra-articular fractures. Sixteen fractures (80%) were managed in the same day of injury. Three fractures (15%) were managed after 2 days and 1 fracture (5%) after 4 days of injury. In 16 cases (80%) surgery was carried out under regional anesthesia and all cases were done under Image intensifier. The mean operative time was 38 (range 30-60) minutes. External fixators were removed after 21- 70 days from application time with the mean time of removal was 27.5 (range 21-70) days. Complete union appeared at 5.7 (range 3-8) weeks. And the mean follow up was 23 (range 10-36) months. TAM results that gained after managing 20 fractures using the external fixator were 6 patients (30%) excellent, 5 patients (25%) good, 4 patients (20%) fair and 5 patients (25%) poor. In this study the results in young ages were more satisfactory than the results in old ages. And from Summary 175 all poor results 80% were in open fractures and 20% were in closed fractures. 80% from all poor results in this study were present in the intraarticular fractures. All results of the fractures caused by gunshot were fair and more poor results were found in fractures caused by animal bites. The satisfactory results (62.5%) were more than the unsatisfactory results (36.5%) in the fractures which had been operated in the 1st day of injury. In the cases where the external fixators were removed after 3 weeks the satisfactory results were 77.7% while the unsatisfactory results were 22.2 %. Over all complication in this study were 9 (45%) out of 20 fractures. Complications varied from infection (5 %), non-union (5 %), stiffness (20 %), and fixator system failure (25 %). The loosening of fixator was the most common cause of poor results. And all patients were satisfied with the results. Mini external fixator is an appropriate method in managing metacarpal and phalangeal fractures. It simplifies surgery, avoids massive soft tissue dissection, affords union (95%) and allows mobilization of adjacent joints. In cases of open fractures, the mini external fixator allows wound inspection and care and avoidance of hardware application at fracture site. anesthesia and can be removed easily in outpatient clinic with no need of second surgery for hardware removal. |