Abstract

FUNCTIONAL OUTCOME EVALUATION OF PHALANGEAL AND METACARPAL FRACTURES TREATED WITH JESS FIXATION

Author(s): Mukharjee G. S, Vindhya K

BACKGROUND Fractures of metacarpals and phalanges are the most common fractures of the upper extremity and account for 10% of total such cases. The outer rays of the hand are most commonly injured. The incidence of metacarpal and phalangeal fractures is most common in males and peaks at the age of 10-40 years a time when the athletic injury and industrial exposure is the greatest. Unfortunately, the metacarpal and phalangeal fractures are often neglected or regarded as trivial injuries. The Proximal Phalanx (PP) of the fingers, fractures are more frequently than the middle or distal phalanges. The deformity with considerable displacement is typical when the PP is fractured. Most fractures are functionally stable either before or after Closed Reduction (CR) and fare well with protective splint and early mobilisation. Closed treatment has gained a poor reputation in unstable comminuted, juxtaarticular and open fractures because of problems of malunion, stiffness and sometimes loss of skin or other soft tissues. Open reduction and internal fixation with K wires, plates and screws further compromises injured soft tissues and leads to infection and stiffness. On the other hand, external fixation allows fracture reduction to normal bone length via a rigid external support. Stiffness can be prevented by mobilisation of joints proximal and distal to the fracture. MATERIALS AND METHODS This prospective study was done from October 2012 to August 2014. 30 patients with 23 phalangeal and 14 metacarpal fractures were treated with external minifixation using JESS fixator at the Department of Orthopaedics, Government General Hospital, Kakinada. Age ranging from 10 years to 60 years. All patients were followed for a minimum of 6 months. The data was analysed with proportion, mean and standard deviation. Functional assessment was done based on total active range of movements in degrees of each injured finger separately according to Duncan et al. RESULTS Age of patients ranged from 10-60 years with most of the patients belonged to 21-40 years age group. Majority of the patients were male (M:F=26:4). The sample size reflected the population visiting the trauma section of our department. Most of the fractures were caused by RTA and were on right hand. Majority of the fractures occurred in proximal phalanx, followed by metacarpal. All patients were followed for a minimum of 6 months and the mean follow-up period was 33.77 weeks. The mean fracture healing in our study was 12.77 weeks. Reviewing the literature, the average radiological healing of phalanges and metacarpals was 4-5 months, which ranged from 1-17 months. The fracture healing time in our study compares favourably with those reported in the literature. Mean duration of implant (JESS) application was 4.42 weeks. Complications like pin tract infection encountered in 5 patients with 3 pin loosening, 1 total stiffness and 10 of them had partial stiffness. CONCLUSION JESS fixation provides an adequate basis for bone healing is a good and simple alternative to standard treatment, especially in open, intraarticular, comminuted and multiple phalangeal and metacarpal fractures.