Miniplate Versus k Wires in Management of Metacarpal Fracture

Study Overview
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Brief Summary
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To compare between buried k wires and miniplate in management of metacarpal fracture.

Detailed Description
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Fractures of the carpals, metacarpals and phalanges account for approximately 15-19% of fractures in adults, with 59% of these occurring in the phalanges, 33% in the metacarpals and 8% in the carpal bones [1]. The single most common fracture site in the hand is the sub capital region of the fifth metacarpal bone (boxer's fracture) [2], which usually results from a direct blow to the metacarpal head [3]. Most hand fractures are caused by accidental falls or other sports-related injuries [4]. Hand fractures are among the most common fractures of upper extremity [5, 6]. Hand fractures can be treated conservatively or surgically, depending on the severity, location and type of fracture. The main objective of both operative and non-operative treatments is to provide fracture stability for early mobilization [7]. Surgical fixation is mainly indicated for displaced fractures because casts are often not sufficient to maintain reduction [8]. Open reduction with internal fixation (ORIF), using pins or plates, has historically been used to stabilize hand fractures which have rotational deformity or lateral angulation [9]. Open reduction may result in scarring, joint stiffness and tendon adhesion [7]. Closed reduction with internal fixation (CRIF), using percutaneous K wire or screws, is now used to treat the majority of unstable closed simple hand fractures [10]. It is generally considered percutaneous Kirschner wire (K wire) fixation may not provide adequate stabilization to allow for early mobilization [8] .

Official Title
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Comparative Study Between Miniplate and Buried k Wires in Management of Metacarpal Fractures

Conditions
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Metacarpal Fracture

Intervention / Treatment
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* Device: miniplate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: ( 20-60) years, Fresh (fixed within 3 days), Single or multiple fractures of metacarpals. Exclusion Criteria: Pathological fracture, Major systemic illness, malignancy, Patient on drugs affecting fracture healing like steroid, anticancer drugs, Polytrauma patients, Extensive comminution of the metacarpal or phalanx detected pre- or intra-operatively, Dislocations at either end of the fractured bone Parents/guardians/patients not willing to participate in study.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: group one<br>patient with metacarpal fracture that will use minipate for fixation | Device: miniplate<br>* comparison between k wires and miniplate in metacarpal fractures<br>* Other names: k wires;|
| Active Comparator: gruop two<br>patient with metacarpal fracture that will use buried k wires for fixation | Device: miniplate<br>* comparison between k wires and miniplate in metacarpal fractures<br>* Other names: k wires;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| miniplate,buried k wires and union | • To compare between union and healing in metacarpal fracture fixation by miniplate versus buried intramedullary k. wires by imaging using anteroposterior and lateral and oblique views x ray to determine union and healing by seeing bridging callus in two or more cortices | 6 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Range of motion | • Range of motion using Functional range of motion (FROM) is defined as the minimum ROM necessary to comfortably and effectively perform ADL. | 6 month |