Advances in osteosynthesis of hand fractures

In recent years stable internal fixation of hand fractures has become more commonly used though the majority of fractures of the hand bones are still treated successfully by other orthopedic means. We feel that in selected fractures internal fixation achieves better results than conservative treatment. Operative methods with less traumatic skin incisions for the fixation of multiple metacarpal fractures are proposed. A retrograde screw fixation technique is presented which permitts application of compression in very small bone fragments, which risk to be crashed by standard screwing. Results of 60 internal fixations of carpometacarpal fractures of the first metacarpal are reported. Follow-up examination of 41 patients between 1-7 years following surgery, revealed posttraumatic arthritis only in 3 joints, although remaining small articular irregularities were frequently seen on X-ray. Secondary angulation occured in four cases in spite fixation. This was due to poor cortical fixation on the palmar side of the fracture, thus in such cases temporary plaster cast should entirely be applied.