Assessing the efficacy of plate fixation for metacarpal fractures

Introduction Multiple surgical options for the treatment of metacarpal fractures are available, including cross-pinning, intramedullary Kirschner wires or screws, and plate and screw fixation. However, despite plate and screw fixation being biomechanically superior to other methods, clinical cases of correction loss and displacement continue to occur. This study aimed to elucidate the incidence of complications and clinical outcomes of plate fixation for metacarpal fractures. Materials and Methods We examined 334 osteosynthesis procedures performed between November 2010 and July 2024. After excluding patients with specific fracture types and complex injuries, a total of 97 cases were analyzed. The collected data included patient demographics, injury details, treatments, and outcomes. The primary outcome was postoperative plate complications and the secondary outcome was postoperative shortening. Statistical analyses were performed using EZR software, while logistic regression and the Akaike information criterion (AIC) were used to identify significant variables. Results The mean follow-up duration was 36 weeks. Plate complications, which included one case of non-union and seven instances of persistent pain, were observed in 14 patients. Postoperative shortening occurred in 55 patients. Transverse fractures significantly increased the risk of plate complications (AIC, 75.09; odds ratio, 14.8; 95% confidence interval, 1.57–139.00). The patients regained sufficient grip strength and range of motion. Conclusion Despite generally favourable outcomes, high postoperative shortening and plate complication rates, particularly with transverse fractures, were observed. These findings challenge the notion that plate fixation provides absolute stability and highlight the need for further research to optimise metacarpal fracture treatment strategies.