A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures

Objective: Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques.

Methods: Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least one year after injury. All fractures were fixated by pinning between years 2013-2015 and by locking plates and screws between 2016-2017. Evaluation included range of motion measurements for all fingers compared to the contralateral hand, comparison of grip strength, finger alignment and rotation, Disabilities of the Arm, Shoulder, and Hand (DASH) score and radiographic measurements of fracture reduction and healing.

Results: 30 patients with 39 fractured metacarpals treated by pinning were compared to 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on x-ray.

Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion and 14° total vs. 10° extension, 19° flexion and 29° total), grip strength (93% vs. 83% of contralateral hand), rotational deformity (5 digits, 1° vs. 15 digits, 6°) and DASH score (10.5 vs. 15.6). Radiographic bone healing time (59 vs. 50 days) and operative time (58 vs. 41 minutes) were both significantly longer in fractures fixated by plates.

Conclusions: Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures