Comparison of closed reduction and percutaneous pinning versus open reduction and internal fixation of closed metacarpal fractures
Vasileios Vasilakis, MD; Catherine J Sinnott, MD; Malack Hamade, BS; Brian Pinsky, MD
Long Island Plastic Surgical Group/Nassau University Medical Center, Garden City, NY
Metacarpal fractures account for more than 30 % of all hand fractures and may be associated with significant morbidity and sequelae. Most metacarpal fractures can be treated non-operatively; however, when surgery is indicated, especially in single, isolated fractures, there is no consensus on the optimal treatment. In cases where operative management is warranted, every technique is associated with advantages and shortcomings. This retrospective study aims to compare the clinical outcomes of single metacarpal fractures treated with closed reduction and percutaneous pinning (CRPP) versus those treated with open reduction and internal fixation (ORIF). We hypothesize that despite increased scarring, ORIF with the use of plates or lag screws allows for earlier mobilization and improved overall outcomes relative to percutaneous pinning.
MATERIALS AND METHODS
The charts of all the patients who underwent surgical repair of their closed metacarpal fractures at our institutions from 2009 to 2016 were reviewed. 70 patients met the inclusion criteria, 44 had undergone CRPP and 26 ORIF with plate or lag screws. Clinical outcomes of both groups were assessed with regards to immobilization time, total active motion (TAM), stiffness, need for revision surgery, complications including infection, and the need for hand therapy.
The immobilization time for the patients treated with ORIF was significantly less than those treated with CRPP (19.7 vs. 31.0 days), whereas TAM was similar between the two groups (225.8 vs. 234.8). There were no significant differences in the complication profiles and occupational therapy rates between the two groups. Two patients needed revision surgery following ORIF versus one status post CRPP. 53.8 % of patients in the ORIF group required occupational therapy versus 70.4 % in the CRPP group. Postoperative stiffness rates were 38.5 and 36.4 %, respectively.
Open reduction and internal fixation of closed metacarpal fractures allowed for faster mobilization when compared with CRPP. This may offer a significant advantage in terms of return to work, return to independent activities of daily living and patient satisfaction versus CRPP.
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