Management of metacarpal and phalangeal fractures with JESS fixator: A prospective study

Abstract

The human hand architected to show an exceptional movements and is often a most vulnerable to various degree of injuries caused often by road traffic accidents and industrial accidents. Treatment of hand injuries involves in joint range improvement and redevelopment of coordinative movements. Joshi's external stabilizing system (JESS) provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints. This study designed to assess the efficacy of JESS in management of Hand injuries. Study includes 50 patients of both sexes and all age groups with open or close type of hand injuries. All the patients were allowed to complete clinical and radiological assessment before and after surgical procedure along with subsequent follow up. Various types of distractors (30%) were applied because majority fractures were intra-articular and in 18% cases basic and extended hand frames were used. Fixators was removed within 6 weeks and in 68% wounds were healed at that time of fixator removal. Swelling was commonly associated complications in 32% cases. The incidence of non-union and delayed union of fractures was 8%, 10% respectively. At the time of final follow up 62.8% metacarpophalangeal joints, 64% of interphalangeal joints, 63% of proximal metacarpophalangeal joints, 63.5% of distal metacarpophalangeal joints and 62% of wrist joints regained their normal movements. In 74% cases grip strength was remains normal. JESS is simple, modular and low expensive. It assists the surgeon in obtaining tissue stabilization, spontaneous revascularization and tissue expansion by gradual and controlled distraction.

Jess Fixator for Metacarpal and Phalangeal Fracture

“…The superficial pin tract infection was seen in 7 cases (18.5%) and loosening of K-wires was observed in 2(5.25%) cases in our study, whereas Naidu et al 14 observed K-wire loosening in 8 cases (16%) and pin tract infection in 7 cases (14%), Drenth et al 17 had 6 cases (11.5%) of K-wire loosening.…”

“…This is comparable to other studies. Naidu et al 14 had 41 (82%) males and 9 (18%) females, Parson et al 15 had 26 (86.66%) males and 4 (13.44%) females and Schuind et al 16 had males 21 (80.7%) and females 5 (19.3%).…”

“…This was comparable to other studies. Naidu et al 14 showed maximum injury rate due to road traffic accidents 15 (30%) followed by machinery 14 (28%). Parson et al 15 showed most injury occurring due to road traffic accidents 11(55%), fall injury 7 (35%) and physical assault 2 (10%).…”

A comparative study of the anatomical and functional outcome between Joshi’s External Stabilization System and Kirschner wire fixation technique for Extra-articular Metacarpal fracture

“…In a study by Naidu et al, the incidence of fractures were more in the age group of 31 -40 years in males and 21 -30 years and more than 51 years in females. 10 A study by Rajkumar et al had reported that, metacarpal fractures were most common in the age less than 30 years. 11 A study by Salunkhe et al had reported that the mean age was 30 years.…”

“…With the use of thin smooth wires, which are places away from the injury site in a stable configuration, Joshi's external stabilizing system (JESS) provides a stable skeletal environment aiding rapid healing of soft tissue wit h establishment of microvascular circulation, immediate active and passive mobilization of the uninjured adjacent joint. 10 JESS is a simple, versatile and light weight fixation with the added possibility of incorporation of splints or conversion to dynamic mobilization units. JESS provides rigid fixation of bones in which other forms of immobilization are not appropriate e.g., open fracture.…”