title: Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis.
abstract: BACKGROUND
  Whether percutaneous pinning or plate fixation is more appropriate for metacarpal fractures is still open to debate. Our study purpose was to review the current literature in an attempt to determine the optimal treatment modality for metacarpal fractures on the basis of functional outcomes, radiographic outcome and rates of complications.
  
  
  METHODS
  We selected Pubmed, Cochrane library, EMBASE and the relevant English orthopedic journals and pooled data from eligible trials including four comparative studies and one retrospective review. Overall, the studies contained 222 patients with 231 fractures, 143 treated with pinning and 88 treated with plates and screws. Mean follow up was 7.5 months (4-12 months). Data were analyzed and the fixed effects are assumed for meta-analysis.
  
  
  RESULTS
  Patients undergoing pinning for metacarpal fractures have higher motion scores when compared to open reduction and internal fixation with plate and screws. Functional scores, grip strength, radiographic parameters, time to union and complications were found not to be significantly different between the two groups.
  
  
  CONCLUSIONS
  There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.
authors.affiliation: * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Eitan
authors.initials: E
authors.lastname: Melamed
authors.affiliation: † Department of Biostatistics, Environmental Health Science Program, New York University, New York, NY, USA.
authors.forename: LiJin
authors.initials: L
authors.lastname: Joo
authors.affiliation: * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
authors.affiliation: * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Donato
authors.initials: D
authors.lastname: Perretta
authors.affiliation: * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Capo
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D050279:Metacarpal Bones / Q000293:injuries / Q000601:surgery*; D000070799:Open Fracture Reduction
keywords: K-wires; Meta-analysis; Metacarpal fractures; Pinning; Plate and screws