Surgical treatment is justified in patients with fifth metacarpal shaft fractures with angulation exceeding 30 degrees, as these patients are prone to have shortening, restriction of movements, decreased efficiency of the flexor tendons and poor cosmetic results1,2. The authors describe a new technique where these patients can be treated in the clinic non-surgically. Twenty-three patients with angulated fractures were prospectively enrolled for the study from Jan 2009 to Dec 2009. After appropriately instructing the patient, an ulnar nerve block was performed at the wrist. Once the nerve block had taken effect, the fracture was manipulated and an ulna gutter 3-point moulded splint was applied in the plaster room. The reduction was then confirmed with an x-ray. The patients were seen at 3 weeks for splint removal and for long-term follow-up at least 6 months later.Introduction
Material and Methods
Treatment for the comminuted intra-articular fractures of base of phalanxes remains a challenging problem in hand surgery. The outcomes are commonly associated with pain, stiffness, chronic instability and degenerative arthritis of proximal interphalangeal (PIP) joints. We present our short term results in 12 consecutive patients suffering from these complex fractures treated by closed reduction and application of a dynamic external fixator (Giddins’s frame). The average range of movement achieved was 11–86 degrees and there were no serious complications. We used the construct with slight modification and in our experience this may be helpful to reduce the pin site infection. It is relatively simple, uses widely available equipment (K-wire), and compact thus allows more than one finger to be treated. Early return to work, good pain relief and high level of patient’s satisfaction was achieved. Our short term results were comparable to best previously published results. Based on our experience we recommend this easy technique to treat these complex fractures of IP joints.
