A Comparison between Open Versus Closed Reduction in the Treatment of Fractures of the Base of the First Metacarpal Bone

Mansour, Mohamed S; El Hadidy, Mohammed R; Ali Salem, Ali S; Yoounes, Reda A. A.

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

Document Type : Original Article

Authors

¹ The Department of Plastic Surgery*, Al-Azhar Teaching Hospital

² Department of Plastic Surgery; Mansoura Unisersity

³ General Surgery Department, Faculty of Medicine, Mansoura University

⁴ Plastic Surgery Department, Faculty of Medicine, ZagazigUniversity

10.21608/ejprs.2023.309718

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.

Keywords

Main Subjects

Hand and Upper Limb Surgery'

References

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