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Long-Term Results Of Articular Fractures Of The Base Of The Thumb Metacarpal Using Different Fixation Methods
Isabella Maria Mehling, PhD; Katrin Schillo, MD; Annika Arsalan-Werner, MD; Michael Schlageter, MD; Michael Sauerbier, MD, PhD
BG Trauma Center Frankfurt am Main, Frankfurt am Main, Germany

Long-term results of articular fractures of the base of the thumb metacarpal using different fixation methods Introduction: Articular fractures of the base of the thumb metacarpal are classified in Bennett`s and Rolando`s fractures. In both fracture types a subluxation in the carpo-metacarpal joint due to traction of the abductor pollicis tendon occurs. Surgical treatment for these unstable fractures is mandatory. There are different options for fixation. The purpose of this study was to find out, which method of operative osteosynthesis can achieve the best functional outcome. Methods: Between May 2002 and September 2013 75 patients (66 men, 9 women) with articular fractures of the base of the thumb metacarpal were treated operatively. In 55 cases a Bennett`s fracture was seen, in 20 cases a Rolando`s fracture. The average age of the patients was 36.4 years. All patients were evaluated retrospectively on the basis of the digital patient files and the existing x-rays. A functional assessment including range of motion of the thumb and pinch and grip strength was performed. Average follow-up was 44 months (12 147 months). Results: The Bennett`s fractures were treated in 25 cases using closed reduction and in 30 cases open reduction technique whereas the Rolando fractures were treated in 4 cases using closed reduction and in 16 cases using open reduction technique. In 23 operations a Kirschner-wire fixation were used, 4 plate osteosynthesis, 14 screw osteosynthesis and 14 screw- and K-wire osteosynthesis in Bennett fractures. Rolando fractures were treated in 6 cases using an external fixator. In 3 cases only K-wire were used and in 11 cases plate osteosynthesis. The mean range of motion for the palmar and radial abduction of the thumb was 85.5 (95% of the opposite side). Most of the patients were satisfied with their outcome (88%). The radiological evaluation showed in 44 cases an intraarticular step less than 1mm, in 17 cases between 1 - 2mm and in 14 cases more than 2mm. Conclusion: The aim of treatment in articular fractures of the base of the thumb metacarpal is a stable osteosynthesis with anatomical reduction. This may lead to good functional outcome with the possibility of early rehabilitation. Different techniques of osteosynthesis can be used. It is difficult to restore the articular surface exactly in these injuries. Our data shows that a step-off up to 1mm obviously has no influence concerning the functional outcome.

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