FUNCTIONAL OUTCOME EVALUATION OF PHALANGEAL AND METACARPAL FRACTURES TREATED WITH JESS FIXATION
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 3
Abstract
BACKGROUND Fractures of metacarpals and phalanges are the most common fractures of the upper extremity and account for 10% of total such cases. The outer rays of the hand are most commonly injured. The incidence of metacarpal and phalangeal fractures is most common in males and peaks at the age of 10-40 years a time when the athletic injury and industrial exposure is the greatest. Unfortunately, the metacarpal and phalangeal fractures are often neglected or regarded as trivial injuries. The Proximal Phalanx (PP) of the fingers, fractures are more frequently than the middle or distal phalanges. The deformity with considerable displacement is typical when the PP is fractured. Most fractures are functionally stable either before or after Closed Reduction (CR) and fare well with protective splint and early mobilisation. Closed treatment has gained a poor reputation in unstable comminuted, juxtaarticular and open fractures because of problems of malunion, stiffness and sometimes loss of skin or other soft tissues. Open reduction and internal fixation with K wires, plates and screws further compromises injured soft tissues and leads to infection and stiffness. On the other hand, external fixation allows fracture reduction to normal bone length via a rigid external support. Stiffness can be prevented by mobilisation of joints proximal and distal to the fracture. MATERIALS AND METHODS This prospective study was done from October 2012 to August 2014. 30 patients with 23 phalangeal and 14 metacarpal fractures were treated with external minifixation using JESS fixator at the Department of Orthopaedics, Government General Hospital, Kakinada. Age ranging from 10 years to 60 years. All patients were followed for a minimum of 6 months. The data was analysed with proportion, mean and standard deviation. Functional assessment was done based on total active range of movements in degrees of each injured finger separately according to Duncan et al. RESULTS Age of patients ranged from 10-60 years with most of the patients belonged to 21-40 years age group. Majority of the patients were male (M:F=26:4). The sample size reflected the population visiting the trauma section of our department. Most of the fractures were caused by RTA and were on right hand. Majority of the fractures occurred in proximal phalanx, followed by metacarpal. All patients were followed for a minimum of 6 months and the mean follow-up period was 33.77 weeks. The mean fracture healing in our study was 12.77 weeks. Reviewing the literature, the average radiological healing of phalanges and metacarpals was 4-5 months, which ranged from 1-17 months. The fracture healing time in our study compares favourably with those reported in the literature. Mean duration of implant (JESS) application was 4.42 weeks. Complications like pin tract infection encountered in 5 patients with 3 pin loosening, 1 total stiffness and 10 of them had partial stiffness. CONCLUSION JESS fixation provides an adequate basis for bone healing is a good and simple alternative to standard treatment, especially in open, intraarticular, comminuted and multiple phalangeal and metacarpal fractures.
Authors and Affiliations
Mukharjee G. S, Vindhya K
Keywords
Related Articles
- EP ID EP450673
- DOI 10.18410/jebmh/2018/55
- Views 62
- Downloads 0
OPERATIVE MANAGEMENT AND EVALUATION OF FRACTURE NECK OF TALUS
BACKGROUND Fractures and dislocations of the talus are a challenging injury. Fractures of the talus are generally thought to be relatively uncommon. However, the talus is the second most commonly fractured tarsal bone. T...
ODONTOGENIC KERATOCYST: A CASE REPORT WITH REVIEW
Odontognic Keratocyst (OKC) may be benign cystic neoplasm, OKC may give an erroneous radiographical impression that they are dentigerous, lateral periodontal, residual, or even so called fissural cyst. It was this belief...
HISTOLOGICAL STUDY OF THYROID GLAND IN SOME MAMMALS
BACKGROUND The sub-Himalayan region is known to be world’s biggest goiter belt in India, but no state can be said to be entirely free from goiter. There is a high incidence of thyroid disorder in the northeastern region...
PRE-OPERATIVE SEDATION USING ORAL CLONIDINE AND ORAL GABAPENTINE: A COMPARATIVE STUDY
Anxiety is a "psychophysiological phenomenon experienced as a foreboding dread or threat to a human organism whether the threat is generated by internal, real or imagined dangers. 1 Anxiety has been described as a subjec...
A PROSPECTIVE STUDY OF CLINICAL SPECTRUM OF “LETHARGIC NEONATE” AND STUDY OF ITS OUTCOME IN RELATION TO BIRTH WEIGHT
To study the clinical spectrum (etiology) of newborn presenting with lethargy, and early recognition of associated problems & the mortality pattern in baby presenting with lethargy in relation to birth-weight.