A comparative study of supercutaneous locking plate, Kirschner wire and external fixator in the treatment of open metacarpal fractures

Abstract

Objective To compare the clinical efficacy of supercutaneous locking plate, Kirschner wire and external fixator in the treatment of open metacarpal fractures, and to analyze the advantages and disadvantages of the three different fixation methods. Methods From March 2015 to February 2017, 62 cases of open metacarpal fractures with poor soft tissue conditions were treated with cross Kirschner wire (group A with 23 cases), external fixator (group B with 20 cases) and supercutaneous locking plate (group C with 19 cases). The clinical effects of the three methods were analyzed from the operation time, plaster external fixation time, fracture healing time, finger joint range of motion and postoperative complications. Results All the three groups were follow-up for 8 to 26 months with an average of 10.6 months. The mean operation time was (25.6±2.6) minutes in group A, (42.3±3.4) minutes in group B and (43.1±4.3) minutes in group C. The mean plaster external fixation time was (5.1±1.0) weeks in group A, (3.6±0.6) weeks in group B and (1.8±0.4) weeks in group C. The mean fracture healing time was (8.5±1.0) weeks in group A, (8.2±0.9) weeks in group B and (6.1±0.7) weeks in group C. The excellent and good rates of finger joint range of motion at 4 and 24 weeks after the operation were 34.8% and 73.9% in group A, 40.0% and 80.0% in group B and 89.5% and 94.7% in group C respectively. The incidence of postoperative complications was 34.8% in group A, 25.0% in group B and 5.3% in group C, respectively. Except the operation time of group C was longer than that of group A and group B, the other indexes were better. Except for the excellent and good rate of finger joint range of motion at 24 weeks after the operation, the other differences had statistical significance (P<0.05). Conclusion For the open metacarpal fractures with severe contamination or soft tissue injuries, the supercutaneous locking plate fixation can achieve better clinical results than cross Kirschner wire and external fixator. Key words: Metacarpal bones; Fractures,bone; Kirschner wire; External fixator; Locking plate