Outcome of unstable fractures of metacarpal and phalangeal bones treated by bone tie.
BACKGROUND
Unstable fractures of the metacarpal and phalangeal bones of the hand need surgical stabilization which should be rigid enough for early active mobilization. Conventional methods of open reduction and stabilization in the form of composite fixation or screws with or without plates have served the purpose but can be definitely improvised addressing both biological and mechanical principles of fixation.


METHODS
34 patients (29 males and 5 females) with an average age of 32 years (range 10-64 years) with unstable fractures of the metacarpal and phalangeal bones of hand who were treated with the modified bone tie between June 2009 and June 2013 were included in this study. 42 fractures, involving the 31 metacarpals and 11 phalanges were included. We have not used this technique in fractures involving the terminal phalanges. Thirty nine of the fractures were treated with K-wires along with the modified bone tie, whereas the other two cases were treated with modified bone tie alone and in one case the bone tie has been used along with the external fixator. The nature of injuries were Road Traffic Accident (n = 24), domestic/industrial injuries (n = 8) and blast (n = 2) injuries. Etiology was crush (n = 24), blunt (n = 7) and incised (n = 3) injuries, respectively. Twenty seven patients were involved with single fractures (either metacarpal or the phalanges), 6 patients had two fractures (both metacarpals or phalanges or one each of metacarpal and phalanx), and 1 patient had three fractures in this study. Dominant hand was involved in 14 patients (40%).


RESULTS
We achieved excellent to good results in 83% of 42 fractures within an average period of 10 weeks. Postoperative grip strength of 85% was achieved with in an average period of 12 weeks. Twenty six (20 metacarpals and 6 phalanges) of the 42 fractures regained >85% of the total active movements (TAMs) compared to the contralateral side were considered excellent results. All patients were followed up for a minimum of 1 year.


CONCLUSIONS
This method of composite fixation allowed the surgeon to remove the concomitantly used axial K-wire at or <3 weeks clearly explaining the biomechanical basis for better results with minimum complication rates.
Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India.
Jagannath B
JB
Kamath
Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India.
Nikil
N
Jayasheelan
Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India.
Amaranth
A
Savur
Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India.
Rejith
R
Mathews
Bone tie; Hand; figner phalanges; fracture; metacarpal; metacarpal bones; phalangeal bones; unstable fractures