Early Functional Outcome of Closed Reduction and Percutaneous Pinning of Proximal Phalangeal and Metacarpal Fractures Done Under Conventional Radiograph Guidance

Abstract

Background. Fluoroscopy is the standard intraoperative imaging in orthopaedic surgery. Real-time visualization of fracture reduction and implant placement is essential, especially during closed reduction and percutaneous pin (CRPP) fixation. In the absence of fluoroscopy, conventional radiographs are used. Objective. This study evaluated the early functional outcomes of CRPP fixation for proximal phalangeal and metacarpal fractures done under conventional radiograph guidance. Methodology. Fifty-four patients with 72 fractures of the metacarpal or proximal phalanx in 70 fingers underwent CRPP fixation at the emergency room. Radiographs were used to assess reduction and fixation. Primary outcome measures were Total Active Motion (TAM), and Disabilities of the Arm, Shoulder, and Hand (DASH) score, while secondary outcome measures included fracture reduction, union rate, and complications. These were all evaluated at a mean of 12 weeks after surgery. Results. An average of 2.9 radiographs were taken for each fracture, with a mean surgical time of 40 minutes. The TAM was “excellent to good” in 47% of fingers (mean = 258°), while the rest had “fair” scores (mean = 235°). Seventy-six percent of patients had a mean DASH score of 4.9. Thirty-five percent of fractures achieved anatomic reduction and maintained until union. Short procedure time did not influence the DASH scores. Complications reported were malunion (2), stiffness (5), and extension lag (7). There was no reported nonunion. Conclusion. Closed reduction with pinning of proximal phalangeal and metacarpal fractures guided by conventional radiograph in the absence of fluoroscopy, remains to be effective and reliable with favorable early outcomes.

Keywords

• radiograph
• closed reduction with percutaneous pinning
• metacarpal
• finger proximal phalanx
• fracture