Mansour, M., El Hadidy, M., Ali Salem, A., Yoounes, R. (2023). A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone. The Egyptian Journal of Plastic and Reconstructive Surgery, 47(3), 201-206. doi: 10.21608/ejprs.2023.309718
Mohamed S Mansour; Mohammed R El Hadidy; Ali S Ali Salem; Reda A. A. Yoounes. "A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone". The Egyptian Journal of Plastic and Reconstructive Surgery, 47, 3, 2023, 201-206. doi: 10.21608/ejprs.2023.309718
Mansour, M., El Hadidy, M., Ali Salem, A., Yoounes, R. (2023). 'A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone', The Egyptian Journal of Plastic and Reconstructive Surgery, 47(3), pp. 201-206. doi: 10.21608/ejprs.2023.309718
Mansour, M., El Hadidy, M., Ali Salem, A., Yoounes, R. A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone. The Egyptian Journal of Plastic and Reconstructive Surgery, 2023; 47(3): 201-206. doi: 10.21608/ejprs.2023.309718
A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone
1The Department of Plastic Surgery*, Al-Azhar Teaching Hospital
2Department of Plastic Surgery; Mansoura Unisersity
3General Surgery Department, Faculty of Medicine, Mansoura University
4Plastic Surgery Department, Faculty of Medicine, ZagazigUniversity
Abstract
Background: Fracture of the thumb occurs most frequently. Thumb damage is expected to occur in 4% of hands fractures, while thumb impairment as a whole reduces 22% of body function. 20% of all fractures of the first metacarpal are caused by the Rolando fracture. Treatment of these fractures is still controversial. There are numerous different surgical therapy options. Objective: To find an effective method for treating bone fractures in the first metacarpal base. Patients and Techniques: This study included 40 patients presented with a fracture at the base of the first metacarpal bone at Plastic Surgery Department, Mansoura University and Al-Azhar Hospital. Patients were divided into closedloop < br />reduction fixed with K-wire (group A), open reduction and internal fixation with plate and screw (group B). Results: Bennet fracture was the most frequent type. First week postoperative follow-up there were statistically significant higher rate of edema, pain, and movement limitation in the open group (group B). Range of movement in open group < br />(group B) was significantly lower than closed group (group < br />A). Conclusion: K-wire Fixation is a beneficial treatment option for a comminuted fracture of the first metacarpal base. The optimum approach would be to combine closed anatomic reduction with effective K-wire fixation of the fracture fragments with early mobilization to prevent joint stiffness.
Williams A.A. and Lochner H.V.: Pediatric hand and wrist injuries. Curr. Rev. Musculoskelet Med., 6 (1): 18, 2013. 2- Peljovich A. and Fishman F.: Median Nerve Injury. Pediatr. Up Extrem. Published Online, August 25: 543-562, 2021. 3- Kollitz K.M., Hammert W.C., Vedder N.B. and Huang J.I.: Metacarpal fractures: Treatment and complications. Hand (N Y), 9 (1): 16, 2014. 4- Windsor T.A., Blosser K.M. and Richardson A.C.: Rolando Fractures. Clin. Case Reports, 7 (12): 2603-2604, 2021. 5- Carter K.R. and Nallamothu S.V.: Bennett Fracture. StatPearls. Published Online, August 11, 2021. Accessed December 19, 2021. 6- Abdellah M., A. Negm M. and Saied A.: Management of intraarticular fracture of the base of the first metacarpal bone by dynamic external fixator. Al-Azhar Med. J., 49 (4): 1497-1510, 2020. 7- Salunkhe R.M., Joshi H., Pisal T.K., Biswas S.K., Patel J.J. and Singh A.: A prospective study of dynamic treatment of fracture phalanx and metacarpals of the hand with Kirschner-wire fixation/external fixator and finger splint: Daycare management (30 cases). Med. J. Dr DY Patil Univ., 9 (6): 708, 2016. 8- Zhang Y., Xu N., Gu W. and Jiang S.: Two-year followup of closed reduction and external fixation treatment of unstable fractures at the base of the first metacarpal. Accessed October 29, 2022. 9- Greeven A.P.A., Alta T.D.W., Scholtens R.E.M., De Heer P. and Van Der Linden F.M.: Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal. Injury, 43 (2): 246-251, 2012. 10- Greeven A.P.A., Bezstarosti S., Krijnen P. and Schipper I.B.: Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: A systematic review. Eur. J. Trauma Emerg. Surg., 42 (2): 169-175, 2016. 11- Diaz-Garcia R. and Waljee J.F.: Current management of metacarpal fractures. Hand Clin., 29 (4): 507-518, 2013. 12- Lutz M., Sailer R., Zimmermann R., Gabl M., Ulmer H. and Pechlaner S.: Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation. J. Hand Surg. Am., 28 B (2): 142-147, 2003. 13- Souer J.S. and Mudgal C.S.: Plate fixation in closed ipsilateral multiple metacarpal fractures. J. Hand Surg. Eur., Vol. 33 (6): 740-744, 2008. 206 Vol. 47, No. 3 / Open Vs Closed Reduction in Fracture of Metacarpal Bone 14- Melamed E., Joo L.J., Lin E., Perretta D. and Capo J.T.: Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis. J. Hand Surg. Asian-Pacific, Vol. 22 (1): 29-34, 2017. 15- Houshian S. and Jing S.S.: Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: A report of 16 cases. Hand Surg., 18 (1): 73-78, 2013. 16- Li Z.Z., Guo Y., Tian W. and Tian G.L.: Closed reduction external fixator fixation versus open reduction internal fixation in the patients with bennett fracture dislocation. Chin Med. J. Engl., 127 (22): 3902-3905, 2014. 17- Capo J.T., Kinchelow T., Orillaza N.S. and Rossy W.: Accuracy of fluoroscopy in closed reduction and percutaneous fixation of simulated Bennett's fracture. J. Hand Surg. Am., 34 (4): 637-641, 2009