Limited open reduction and internal fixation combined with mini-external fixator for open comminuted metacarpal and phalangeal fractures

Objective To explore the method and clinical outcome of limited open reduction and internal fixation combined with mini-external fixator for treatment of open comminuted metacarpal and phalangeal fractures.Methods From March 2008 to August 2011,40 patients (27 males and 13 females) with open comminuted metacarpal and phalangeal fractures were treated.The patients' age ranged from 19 to 62 years,with an average of 31.2 years.There were 17 cases of metacarpal fractures,19 cases of phalangeal fractures,and 4 cases of both metacarpal and phalangeal fractures.Mini unilateral external fixator was used in all the cases along with limited internal fixation by Kirschner wire and absorbable suture.Flap transfer was carried out in 2 cases and skin graft in 2 cases with severe soft tissue injury.Direct tenorrhaphy was done in 6 cases with tendon ruptures.Results All the fractures healed 9 weeks postoperatively.Pin loosening occurred in 2 cases while mild pin track infection occurred in 3 cases,all of which did not affect the outcome.4° of phalange rotation was noted in 1 case.The upper limb functional evaluation criteria issued by the Chinese Hand Surgery Society was used to assess the motion function of the injured fingers and rate the overall results,which were excellent in 12 cases,good in 21 cases,fair in 5 cases and poor in 2 cases.The overall good-excellent rate was 82.5％.Conclusion Limited open reduction and internal fixation combined with mini-external fixator is a reliable and effective method to treat open comminuted metacarpal and phalangeal fractures.It allows early postoperative functional rehabilitation and restores the hand function. Key words: Fractures, open; Fractures, comminuted; Metacarpal bones; Finger phalanges; External fixator; Limited internal fixation