Pin vs plate fixation for metacarpal fractures: a meta-analysis
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(2020) 15:542
RESEARCH ARTICLE
Open Access
Pin vs plate fixation for metacarpal fractures: a meta-analysis Xiangting Zhu1, Hongwei Zhang1, Jingying Wu2, Shiwei Wang3 and Lin Miao1*
Abstract Background: The differences in the clinical and functional outcomes of closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screws have been systematically synthesized by one meta-analysis. With newer studies being published, an effort to update the earlier meta-analysis is necessary. Methods: Comprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. Randomized controlled trials, quasi-experimental studies, prospective comparative non-randomized studies, and even studies reporting findings from retrospective chart review were eligible to be included. Statistical analysis was done using STATA version 13.0. GRADE assessment was done to assess the quality of pooled evidence. Results: A total of 9 studies were included. The pooled estimates did not suggest any significant differences in the disabilities of the arm, shoulder, and hand (DASH) score [WMD − 0.77; 95% CI, − 3.55, 2.00; I2 = 75.5%], range of movement (ROM) of the metacarpophalangeal joint (o) [WMD 4.44; 95% CI, − 4.19, 13.07; I2 = 86.0%], and grip strength [WMD − 4.63; 95% CI, − 14.52, 5.26; I2 = 86.9%] among the two intervention modalities. No difference was seen in the risk of complications between the two interventions (RR 0.93; 95% CI, 0.57, 1.53; I2 = 31.2%). For all the outcomes, the quality of pooled evidence was judged as low to very low. Conclusion: No significant long-term differences were noted in the functional outcomes suggesting that both these techniques are comparable. The choice of modality should be made based on the skills and preference of the surgeon and availability of resources. Keywords: Metacarpal fractures, Percutaneous pin fixation, Open reduction with internal fixation, Meta-analysis
Background Emergency departments usually have a high inflow of patients with hand injuries, and metacarpal fractures represent around half (40%) of these hand injuries [1, 2]. Metacarpal fractures often comprise a large proportion of all hand fractures and fractures below the elbow, particularly in industrialized environments such as the USA [2–4]. Either accidental falls or direct impact trauma is responsible for most of these fractures. Clinical evidence * Correspondence: [email protected] 1 Department of Orthopedics, Zaozhuang Hospital of Traditional Chinese Medicine, 2666 Taihangshan Road, Zaozhuang 277000, Shandong, People’s Republic of China Full list of author information is available at the end of the article
shows that the neck of the metacarpal, the fifth metacarpal in particular, is the most affected [3]. The main goal of surgical management is to restore the bony shape, to enhance early mobilization, and to avoid functional impairment [3, 4]. Current metacarpal fracture management relies
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