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

Discussion

Our results showed that this light-weight, radiolucent, readily available, and inexpensive external fixator system provided stable fixation and achieved good or excellent clinical and functional outcomes in 37 of 48 metacarpal and phalangeal fractures. External fixation for unstable metacarpal and phalangeal fractures has been a gold standard in many centers. Although most metacarpal and phalangeal fractures are treated conservatively, patients with displaced fractures require operative intervention and stabilization to obtain the optimal bony alignment and angulation for healing. One of the most important parameters to achieve good hand function is allowing early motion, as finger immobilization more than 3 wk has been reported to increase the incidence of stiffness.[12]

The concept of external fixation for hand fractures has been deemed to achieve adequate bony fixation with early hand motion comparable to more rigid fixation with plates and screws, which were not always related to better outcomes.[13] To our knowledge, Lambotte (1904) was the first to use an external fixator in hand fractures.[14] Later, wires drilled through acrylic resins,[15–18] or through plastic portions of needles[9,19–21] were used to increase the versatility of Kirschner wire arrangement according to the fracture pattern.

Since the introduction of the external fixation concept for management of displaced hand fractures, many studies have reported variable promising results.[6,22–24] Despite that, external fixation never gained popularity compared to internal fixation techniques. This may be attributed to refusal of principle by many surgeons, lack of experience, or market direction.

As for similar studies using external fixators, Drenth and Klasen[7] reported 41.7% excellent results, 27.8% good results, 8.3 fair results, and 22.2% poor results. Ma et al.[25] reported that results were excellent in seven (25%) fractures, good in 12 (42.9%), fair in five (17.9%), and poor in four (14.2%) of 28 digital fractures. Lu et al.[13] reported 26 patients with comminuted intraarticular fractures, and the results were excellent in eight (30.9%), good in 13 (50%), fair in three (11.5%), and poor in two (7.6%). In our study, 11 fractures (23%) were intraarticular, and of these eight fractures (73%) showed excellent results, two showed fair results (18%), and one (9%) redisplaced and required revision.

An association between the location of a fracture and the functional outcome has been mentioned in one study.[7] In that study fractures of the middle phalanx achieved better functional outcomes than fractures of proximal phalanges. Although such a relation seems logical, we did not find such an association in our study.

System failure and loosening has been reported with little incidence in two studies.[8,23] Schuind et al.[23] reported system failure in 7.5% of patients. In the study by Lenehan et al.,[8] one patient developed fixator loosening that required adjustment in the outpatient department. In our study, no system failures or wire loosening of fixators were observed. Taking this into account, the light external fixator system as used in our study could be competitive to commercial fixators because there is adequate rigidity, it is lightweight, simple to construct, and its components are readily available in all trauma theaters. In addition radiolucency of the rod allows for easier radiographic assessment intraoperatively and postoperatively, the free-hand wire replacement is simple with no clamp used, and it is easily removed at an outpatient clinic visit.

This study has several limitations. First, it was a noncomparative study that described the results of a single surgical technique in all patients, which might create bias. Second, patient selection was consecutive, nonblinded, and nonrandomized, which could affect the control of bias. Third, follow-up was relatively short to midterm. A longer follow-up could reveal the occurrence of more complications related to re-fracture or development of tendon complications. Ideally, a prospective, randomized, blinded study that compares this technique with open reduction and internal fixation, for example, would definitely be more suitable to elaborate stronger clinical evidence.

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