Pin vs plate fixation for metacarpal fractures: a meta-analysis

Abstract

Background The differences in the clinical and functional outcomes of closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screws have been systematically synthesized by one meta-analysis. With newer studies being published, an effort to update the earlier meta-analysis is necessary. Methods Comprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. Randomized controlled trials, quasi-experimental studies, prospective comparative non-randomized studies, and even studies reporting findings from retrospective chart review were eligible to be included. Statistical analysis was done using STATA version 13.0. GRADE assessment was done to assess the quality of pooled evidence. Results A total of 9 studies were included. The pooled estimates did not suggest any significant differences in the disabilities of the arm, shoulder, and hand (DASH) score [WMD − 0.77; 95% CI, − 3.55, 2.00; I2 = 75.5%], range of movement (ROM) of the metacarpophalangeal joint (o) [WMD 4.44; 95% CI, − 4.19, 13.07; I2 = 86.0%], and grip strength [WMD − 4.63; 95% CI, − 14.52, 5.26; I2 = 86.9%] among the two intervention modalities. No difference was seen in the risk of complications between the two interventions (RR 0.93; 95% CI, 0.57, 1.53; I2 = 31.2%). For all the outcomes, the quality of pooled evidence was judged as low to very low. Conclusion No significant long-term differences were noted in the functional outcomes suggesting that both these techniques are comparable. The choice of modality should be made based on the skills and preference of the surgeon and availability of resources.

A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures

“…25 Other commonly reported postoperative complaints in our cohort, such as contractures and extensor lag, were not described in most studies captured by the meta-analysis. 24,26 In the current cohort of metacarpal fixation patients, approximately half (51.3%) of our reported complications were symptoms of stiffness. Stiffness has been associated with factors external to intraoperative technique, such as immobilization time and postoperative therapy regimen.…”

“…Although less prevalent than with phalangeal fracture fixation, complications after metacarpal fixation are still common. 24 , 25 A recent meta-analysis of comparative studies examining pin versus plate fixation of metacarpal fractures demonstrated complications occurring in 40 out of 249 pooled subjects (16%). 24 However, unlike the current study, many of the studies described by this meta-analysis did not report minor complaints, such as stiffness, which may have contributed to the discrepancy in overall complication rates.…”

Treatment of hand and finger fractures with the Stryker Hand Plating System

“…The aim of this retrospective study was to demonstrate the performance and safety of the Stryker Hand Plating System. This study differs from many publications that either compare different osteosynthesis procedures or focus on finger function [ 8 ], [ 9 ]. All patients of our hospital which underwent reconstruction of finger fractures with plate and with complete documentation were included.…”

The curative effect analysis of a modified Kirschner wires and locking plate internal fixation method for the fifth metacarpal neck fracture

“…The surgical indications for the fifth metacarpal neck fracture have always been controversial [ 11 – 13 ]. For the fifth metacarpal neck fractures with angulation more than 30°, most surgeons agree that surgical treatment is more effective than conservative treatment [ 14 , 15 ].…”