title: Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures.
abstract: OBJECTIVE
  This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures.
  
  
  METHODS
  Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013. Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement, fracture complexity, and surgeon's experience and were then treated accordingly. Relevant demographic, clinical and preoperative clinical data were collected and analyzed. Clinical examination and radiograph evaluation were performed 1 week and 1, 3, and 6 months postoperatively. Outcome measures were visual analog scale (VAS) scores for pain, total range of motion (ROM) of the injured digit, Quick Disabilities of the Arm, Shoulder, and Hand scores (Quick-DASH) and grip strength (percentage of the contralateral corresponding digit).
  
  
  RESULTS
  From July 2013 to September 2014, 76 patients were treated by AIM and 71 by ATLPS. Age, sex, time from injury to operation, dominant hand, injury mechanism, fracture location, fracture type and participant occupation were similar in both groups (P > 0.05). Operations were all performed well and followed by uneventful postoperative functional recoveries. At 3-month follow-up, all clinical outcomes were significantly better in the AIM than ATLPS group ( P < 0.05) except for VAS pain scores. However, at 6-month follow-up, the differences were no longer significant, indicating similar results for both types of fixation. Patients in the AIM group developed significantly more complications ( P = 0.037). Sick leave was significantly longer in the AIM group ( P = 0.02).
  
  
  CONCLUSIONS
  AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Pan
authors.initials: P
authors.lastname: Hu
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Kun-Lun
authors.initials: KL
authors.lastname: Yu
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Jiang-Bo
authors.initials: JB
authors.lastname: Bai
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: De-Hu
authors.initials: DH
authors.lastname: Tian
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Gui-Sheng
authors.initials: GS
authors.lastname: Zhang
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Xin-Zhong
authors.initials: XZ
authors.lastname: Shao
authors.affiliation: Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China. dryzzhang@126.com.|Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China. dryzzhang@126.com.|Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China. dryzzhang@126.com.
authors.forename: Ying-Ze
authors.initials: YZ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D050278:Finger Phalanges / Q000293:injuries* / Q000601:surgery; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D014025:Titanium; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014025:Titanium
keywords: Anterograde intramedullary fixation; Locking plate fixation; Metacarpal fractures; Phalangeal fractures