Light Syringe Barrel (External Fixator) for Phalangeal and Metacarpal Fractures

A Case Series

Mahmoud M. Abdallah, MD; Ahmed Nageeb Mahmoud, MD; Ashraf Nehad Moharram, MD; Sherif Nabil Amin, MD; Ayman Mansour, MD

Disclosures

Curr Orthop Pract. 2020;31(1):90-95. 

In This Article

Abstract and Introduction

Abstract

Background: External fixation is a well-established technique for management of displaced metacarpal and phalangeal fractures. External fixation can achieve adequate fixation with relatively low complications.

Methods: This is a study of 45 patients (48 digits) with phalangeal and metacarpal fractures that were managed using a simple light external fixator system. Eighteen patients had a comminuted fracture pattern, sixteen had a transverse, ten had an oblique, and two had a spiral fracture pattern. Radiographic outcomes were reviewed on a regular basis after surgery. Functional outcomes were assessed using total active motion of the digit and plotted using the American Society for Surgery of the Hand (ASSH) score.

Results: All the patients achieved radiographic fracture union at a mean duration of 6 wk (average 4–8 wk). As for functional outcomes according to the ASSH score, excellent results were achieved in 34, good results in three, fair results in nine, and poor in two. One patient had redisplacement that required revision internal fixation. Fair and poor results were found mainly in elderly and uncooperative patients due to noncompliance with postoperative hand mobility exercises.

Conclusions: The light external fixator system provided a simple, easy, cheap, and adequate technique for management of displaced metacarpal and phalangeal fractures, with good radiographic and clinical outcomes. Strict adherence to hand motion exercises is mandatory to achieve favorable outcomes.

Level of Evidence: Level IV.

Introduction

A variety of injuries may occur to the hand bones especially in industrial, agricultural, and manual jobs. Metacarpal and phalangeal fractures of the hand, being closed or open, represent 10% of upper extremity fractures.[1] The thumb and little fingers are the most commonly injured digits, with the peak occurrence noted between the ages of 10 and 40 yr. There is a higher occurrence in males. Whether the fracture is extraarticular or intraarticular, the management goals are to achieve adequate fracture fixation, restore the articular congruity, and to regain hand range of motion. Improper management could result in chronic pain and degenerative arthritis with subsequent detrimental functional outcomes.[2]

Most phalangeal and metacarpal fractures are treated conservatively. Surgical management is indicated in unstable fractures. There are two types of fixation techniques: internal fixation (AO standards) and external fixation, which has been used mainly for patients with open unstable fractures and/or with severe soft-tissue injuries. External fixation devices, which allow for indirect reduction with ligamentotaxis, may reduce further injury to the soft tissues and bone, allow for adequate range of motion exercises of the fingers at an early stage, and allow for proper wound care.[3,4] Since its introduction, indications for external fixation in hand bone fractures has been extended to include closed injuries, owing to good clinical outcomes and the relatively low complications compared to open reduction and internal fixation (ORIF) techniques.[3–7]

External fixators offer significant advantages in the form of minimal surgical trauma, preservation of fracture hematoma, short operative time, and minimal anesthetic complications especially among older patients not fit for general anesthesia. Moreover, removal of the fixator usually is performed as a simple outpatient procedure.[7,8] In 1998 Godwin and Arnestein[9] invented a simple and cheap disposable external fixator system using a syringe barrel and Kirschner wires. The purpose of the current study was to revisit and review the clinical and radiographic outcomes of this simple, low-cost technique in the management of both metacarpal and/or phalangeal fractures in a larger patient group.

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