Complications of Low-Profile Plate Fixation in Metacarpal Fractures
Rita E Baumgartner, MD1; Andrew E Federer, MD2; Erin M Meisel, MD2; Suhail K. Mithani, MD3; David S Ruch, MD1; Marc J Richard, MD4; (1)Duke University, Durham, NC, (2)Duke University Health System, Durham, NC, (3)Plastics and Reconstructive Surgery, Duke University Medical Center, Durham, NC, (4)Department of Orthopaedic Surgery, DUKE UNIVERSITY, Durham, NC
Introduction: Unacceptably high complication rates have been reported using conventional plating systems to treat metacarpal fractures. We investigated complication rates in metacarpal fractures treated with low-profile anatomic plates.
Materials & Methods: A retrospective chart review was performed of patients with metacarpal fractures who were treated with open reduction and internal fixation (ORIF) using low-profile anatomic plates by fellowship-trained hand surgeons at a single institution from 01/2010 to 02/2017. Patients with concomitant tendon injury, prior same metacarpal fracture, or thumb metacarpal fracture were excluded. Seventy nine patients with 110 metacarpal fractures were included in the review. The primary outcome was any complication. Complications included superficial or deep infection, delayed wound healing, delayed union (lack of consolidation at 3 months), nonunion (no evidence of bony union at 6 months), major extensor lag or stiffness at 90 days after surgery (lag >35 degrees or total active flexion [TAF] <180 degrees), minor extensor lag or stiffness at 90 days after surgery (lag>15 degrees or total metacarpophalangeal joint [MCPJ] flexion <75 degrees), and return to the operating room (OR).
Results: Nine patients (11%) and 11 fractures (10%) had one or more complications. Complications included 4 patients with major extensor lag or stiffness (5%), 4 patients with minor extensor lag or stiffness (5%), 1 patient with delayed radiographic union that did not require operative intervention (1%), and 1 patient with return to OR for removal of hardware, extensor tenolysis, and MCPJ contracture release (1%).
Conclusions: In this retrospective review, treatment of metacarpal fractures with low-profile plate fixation resulted in an 11% overall complication rate and a 1% re-operation rate. This is significantly less than reported in previous literature prior to the widespread use of low-profile plates. This study suggests that treatment of patients with metacarpal fractures using low-profile plating systems provides a reliable solution with acceptable complication rates.
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