Updates
New modified rehabilitation regime for internally fixed metacarpal fractures

Metacarpal fractures account for 40% of all hand injuries and up to 44% of all hand fractures. While we are still collecting and processed data, preliminary results are suggesting that splint is neither needed, nor beneficial for patients who have undergone uncomplicated, rigid, internal fixation of metacarpal fractures.

My team presented results of our latest prospective randomised control trial at the IFSSH, IFSHT & FESSH Combined Congress in London last week. Whilst we continue with the painstaking data collection, started few years ago, some conclusive results are starting to emerge.

We wanted to test the widely practiced, conventional rehabilitation regime of splintage of patients with metacarpal fractures, even after uneventful and rigid surgical fixation with internal metalwork (Open Reduction Internal Fixation – ORIF method, see examples below). Study has been ethically approved and we have so far analysed data from over 30 cases.

 

Patients have been prospectively randomised into 2 groups:
– Group A – splinted cohort with operated hand being protected with conventional volar resting splint in position of functional safety for minimum of 2 weeks (Picture, left), and
– Group B – control cohort of patients in whom no splint has been used and patients were encouraged to move fingers and wrist unrestrictedly after surgery (except for sport activities and heavy manual work), (Picture, right).

A          

Functional outcome measures (grip strength testing, DASH), pain scores and active range of motion (AROM) were collected at 1, 2 ,4, and 12 weeks post-surgery. The results are showing that, if metacarpal fragments have been fixed in a predictably robust (ORIF) way, splint and immobilisation are not necessary. Our control, Group B that did not use splint, achieved comfortable and pain free recovery, better range of movement, returned to work 9.5 days earlier, and was able to drive 12 days earlier than the immobilised Group A.

Fine and light, but modern and strong plates and screws designed for hand fractures, allow early bone loading and hand mobilisation, which prevents stiffness. Given the additional cost, follow up appointments and prolonged stiffness associated with hand splintage, we recommend that no splint is used in patients who have undergone uncomplicated, rigid fixation of metacarpal fractures.

 

RECENTLY PUBLISHED
New modified rehabilitation regime for internally fixed metacarpal fractures

Metacarpal fractures account for 40% of all hand injuries and up to 44% of all hand fractures. While we are still collecting and processed data, preliminary results are suggesting that splint is neither needed, nor beneficial for patients who have undergone uncomplicated, rigid, internal fixation of metacarpal fractures.

Ten year study on use of special implants for thumb arthritis published in JHS

In my practice, interposition arthroplasty using pyrocarbon implants still represents a useful and reliable treatment option in the surgical treatment of early thumb basal joint arthritis.

Advances in Hand Surgery 2021 

I was delighted to participate in Advances in Hand Surgery Course which connected virtually so many surgeons, trainees and therapists over the last 3 days.

Practice reopening

As lockdown restrictions ease off, we are able to welcome new and follow up patients again.

Contact

All enquiries are handled

by the Practice Manager:

Shirley Jordan Chihi

Tel: +44 (0) 845 026 7776

Email: contact@sonjacerovac.com

Correspondence address:

Miss Sonja Cerovac

Ashtead Hospital

The Warren

Ashtead, Surrey KT21 2SB