الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Phalangeal and metacarpal fractures either closed or open, are
common injuries of the hand. These fractures can be treated
conservatively or operatively depending on the nature of injuries, fracture
pattern and the fracture stability.
The principles of management involve restoration of articular
congruity and fixation of the fracture with an internal or external fixation
device. Early mobilization of the affected joint improves functional
outcome.
Conservative traditional treatments may not get optimal results,
and many times result in some sequel such as collapse and stiffness.
Mini plate and screw, k-wires either ante grade, retrograde or
transverse, tension band and flexible inter medullary nails are common
methods of internal fixation.
Internal fixation by plates and screws required open wound,
dissection and K- wire usually leads to incapability of early mobilization
secondary to smaller size of bone fragments or less fastness in fixation
dragged by local ligament.
In highly comminuted fractures, intra-articular fractures and open
fractures external fixation offers an effective treatment option in the
management of these difficult fractures and a variety of external fixators
are available for this purpose. It has advantages as it often simplifies
surgery by being both quick and easy to apply as well as it allows
fracture reduction to normal bony length via a rigid external support,
reduces further damage to the delicate soft tissues and bone.
Summary 174
In addition, external fixation allows wound care and enables exercise
of the finger joints at an early stage. It avoids internal dissection, yet
provides fracture stability and easier soft tissue access and management.
This prospective study was undertaken to assess the use of external
fixator in the management of metacarpal and phalangeal fractures.
In this study 20 patients had been managed in El-Menofia University
Hospital and El-Menshawy Hospital between April 2010 and January
2014. And all the patients were followed up for at least 6 months
fractures
The mean age of the patients was 36.7 (range: 21-62) years. All
patients were males (100 %). There were 10 (50%) open fractures and 10
(50%) closed fractures. There were 13 (65%) extra-articular and 7 (35%)
intra-articular fractures.
Sixteen fractures (80%) were managed in the same day of injury.
Three fractures (15%) were managed after 2 days and 1 fracture (5%)
after 4 days of injury. In 16 cases (80%) surgery was carried out under
regional anesthesia and all cases were done under Image intensifier. The
mean operative time was 38 (range 30-60) minutes.
External fixators were removed after 21- 70 days from application
time with the mean time of removal was 27.5 (range 21-70) days.
Complete union appeared at 5.7 (range 3-8) weeks. And the mean follow
up was 23 (range 10-36) months.
TAM results that gained after managing 20 fractures using the
external fixator were 6 patients (30%) excellent, 5 patients (25%) good, 4
patients (20%) fair and 5 patients (25%) poor. In this study the results in
young ages were more satisfactory than the results in old ages. And from
Summary 175
all poor results 80% were in open fractures and 20% were in closed
fractures. 80% from all poor results in this study were present in the intraarticular
fractures. All results of the fractures caused by gunshot were fair
and more poor results were found in fractures caused by animal bites. The
satisfactory results (62.5%) were more than the unsatisfactory results
(36.5%) in the fractures which had been operated in the 1st day of injury.
In the cases where the external fixators were removed after 3 weeks
the satisfactory results were 77.7% while the unsatisfactory results were
22.2 %.
Over all complication in this study were 9 (45%) out of 20 fractures.
Complications varied from infection (5 %), non-union (5 %), stiffness (20
%), and fixator system failure (25 %). The loosening of fixator was the
most common cause of poor results. And all patients were satisfied with
the results.
Mini external fixator is an appropriate method in managing
metacarpal and phalangeal fractures. It simplifies surgery, avoids massive
soft tissue dissection, affords union (95%) and allows mobilization of
adjacent joints. In cases of open fractures, the mini external fixator allows
wound inspection and care and avoidance of hardware application at
fracture site.
anesthesia and can be removed easily in outpatient clinic with no need of
second surgery for hardware removal.