Surgical Outcomes after Metacarpal Shaft Fractures Management at Zagazig University Hospitals

Metacarpal fractures are among the most prevalent injuries evaluated in the emergency setting, comprising about 30% of all hand fractures and 18% of all below-elbow fractures. Unfortunately, these fractures are often neglected or regarded as trivial injuries. Incorrect diagnosis and management of metacarpal and phalangeal fractures can have catastrophic consequences for patients, as much morbidity and disability can be prevented by establishing proper management at initial evaluation.This study is aimed to evaluate the outcome of the surgical management of metacarpal shaft fractures as regarding functional, radiological outcomes and complications. A prospective study were operated on 18 consecutive patients presented by metacarpal shaft fractures and associated 3 phalangeal fractures were managed by two methods of surgical fixation; percutaneous pinning (PCP) by different techniques and open reduction internal fixation (ORIF) using mini- plates and mini-screws. They were followed up for a mean period of 6.8 +/- 1.1 (SD) months; range (6-9) months. There is statistically insignificant difference between clinical and radiological outcome as regarding type of operation among studied patients. The percent of excellent level of TAM score in close fracture was 53.8% while none of open fracture patients had excellent level of TAM score, the difference is statistically significant p<0.05. The mean of DASH score in closed fracture was 2.4, while in open fracture was 15.5, the difference is statistically significant p<0.05 i.e. DASH score was better in closed than open fractures. Open metacarpal fractures had an unsatisfactory functional outcome. This could be attributed to the severity of soft tissue injury and increased possibility of associated injuries as cut extensor tendons compromising both wound healing and tendon gliding mechanism, thus delaying finger movement and affecting the grip strength. Prolonged postoperative immobilization should be avoided and patients must start active movement as early as possible to avoid stiffness.