Hand function outcome in closed small bone fractures treated
by open reduction and internal xation by mini plate or closed crossed
pinning: a randomized controlled trail
· N. Soni
· H. Bhayana
· R. Malhotra
· A. Pankaj
· S. S. Arora
Received: 7 May 2017 / Accepted: 20 May 2018
© Istituto Ortopedico Rizzoli 2018
Purpose No study in literature clearly gives advantage of one method of surgical ﬁxation of fracture over the other in meta-
carpal and phalangeal bones of hand comparing wider outcome measures.
Materials and methods A randomized controlled trial between closed reduction and percutaneous Kirschner wire ﬁxation
or open reduction and internal ﬁxation with mini fragment plates was conducted. A total of 32 patients with 16 in each
group were taken in tertiary-level teaching hospital from 2014 to 2016. Four patients lost to follow-up apart from 32 studied.
Inclusion criteria were age group 16–60 years, fresh (3 days) closed shaft fractures of metacarpal and phalanges. Outcome
evaluated were time to union of fracture, degree of strength achieved measured with dynamometer, DASH scoring, range
of motion of hand and each digit.
Results Both groups were comparable in terms of return to full hand function, union and total range of motion. K wire ﬁxa-
tion results were slightly better than plating group in terms of early DASH score and grip strength after ﬁxation.
Conclusion No modality was found to be superior for ﬁxation of small bone fractures of hand. But K wire being cheaper
and without inherent complication of plating like scar and tendon irritation, K wire ﬁxation is preferred over plating in shaft
fractures of metacarpal and phalanges.
Level of evidence Level I Therapeutic study.
Keywords DASH score · Kirshner wire · Metacarpal
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 . The single most common fracture
site in the hand is the subcapital region of the ﬁfth metacar-
pal bone (boxer’s fracture) , which usually results from a
direct blow to the metacarpal head . Most hand fractures
are caused by accidental falls or other sports-related injuries
. 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 treat-
ments is to provide fracture stability for early mobilization
. Surgical ﬁxation is mainly indicated for displaced frac-
tures because casts are often not suﬃcient to maintain reduc-
tion . Open reduction with internal ﬁxation (ORIF), using
pins or plates, has historically been used to stabilize hand
fractures which have rotational deformity or lateral angula-
Open reduction may result in scarring, joint stiﬀness and
tendon adhesion . 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
. It is generally considered percutaneous Kirschner wire
(K wire) ﬁxation may not provide adequate stabilization to
allow for early mobilization .
* R. Pandey
University College of Medical Sciences, Delhi, India
Max Health Care, Delhi, India
Fortis Shalimar Bagh, Delhi, India
Department of Orthopedic, AIIMS Rishikesh, Rishikesh,