Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis

Abstract

There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.

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

“…However, we did find that patients undergoing closed reduction and percutaneous pin fixation had comparatively higher shortening on radiological assessment compared to those receiving open reduction with internal fixation (ORIF) using plate and screws, and this was most prominent in study subjects younger than 30 years. Our findings are similar to the previous meta-analysis by Melamed et al [9]. The earlier meta-analysis included 5 studies, and our review included 4 additional studies.…”

“…However, we have additionally shown that in the longer course (i.e., at > 1 year post-operatively), there are no statistically significant differences in the ROM between the two treatment modalities. The findings that functional scores and grip strength were not significantly different between the two groups corroborated with the findings of the earlier meta-analysis [9].…”

“…Through inclusion of four comparative studies and one secondary data review providing a sample of 222 patients, this meta-analysis found higher motion scores in subjects undergoing pinning for metacarpal fractures compared to ORIF with plate and screws. However, no significant differences were observed for functional scores, grip strength, radiographic parameters, and time to union [9]. With newer studies being published, an effort to update the earlier metaanalysis could shed more light on the comparative clinical and functional efficacy of the two treatment modalities.…”

“…Due to variability in the sample population, surgical experience, and operational definitions of the outcomes considered, recent attempts to compare plate and pin fixation for metacarpal fractures have yielded mixed and equivocal results. Till date, the outcomes for these two treatment modalities have been systematically synthesized by one meta-analysis [9]. Through inclusion of four comparative studies and one secondary data review providing a sample of 222 patients, this meta-analysis found higher motion scores in subjects undergoing pinning for metacarpal fractures compared to ORIF with plate and screws.…”

Extra-articular Metacarpal Fractures: Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation

“…Interestingly, a recent meta-analysis conducted by Melamed et al 18 comparing CRPP with K-wires to ORIF with plate and screws for the treatment of unstable metacarpal fractures, focusing on functional outcomes, found statistically significant improved TAM scores with CRPP on their weighted mean analysis of the 3 studies that reported TAM scores. The authors did not find a difference in DASH scores or other functional outcome variables.…”