title: Osteosynthesis using plates and screws after removing a limited area of the periosteum in order to reduce misclassified during radiological assessment metacarpal shaft fractures.
abstract: Hand fractures are one of the most common causes for presenting to the emergency room. Metacarpal fractures count about 18 to 44% of all hand fractures, and are most often standalone closed injuries, without misplacement, not needing operative treatment. We present a case in which osteosynthesis with plates and screws was used to reduce two metacarpal fractures in order to allow an early motion recovery, despite the fact that a small portion of the periosteum needed to be removed. The type of fractures were misclassified according to the radiological findings, therefore the correct diagnosis was established during surgery. The results according to the radiological aspects and to the DASH score were excellent with 95% function recovery at twelve months. In this case, the use of osteosynthesis with plates and screws led to a good fracture healing without any major complications. However, there are a series of complications related to this method that should be taken into consideration. Being misled by the radiological aspects of the fractures, the most certain way to classify a metacarpal shaft fracture is through exploratory surgery, even if in most of the cases the three radiological views are enough to establish the diagnosis.Abbreviations:DASH score = Disability of Arm, Shoulder and Hand score, TAM = Total Active Motion, MCP = metacarpal phalangeal joint, PIP = proximal inter phalangeal joint.
authors.affiliation: Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, Romania ; 11th Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: T P
authors.initials: TP
authors.lastname: Neagu
authors.affiliation: Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, Romania ; 11th Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: S A
authors.initials: SA
authors.lastname: Popescu
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital of Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Cobilinschi
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital of Bucharest, Romania ; 14th Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Tincu
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital of Bucharest, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Tiglis
authors.affiliation: Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, Romania ; 11th Clinical Department, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Lascar
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D050278:Finger Phalanges / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D010521:Periosteum / Q000601:surgery*
keywords: DASH score; metacarpal; misclassified; plates and screws