A retrospective study on pattern and outcome of metacarpal and phalangeal fractures of the hand as seen in K.N.H from Jan.1999 To Dec 1999

Abstract

This is a retrospective study {descriptive} on metacarpal and phalangeal fractures of the hand on patients who presented to Kenyatta National Hospital over a one-year period from 1st Jan. 1999 to 31 st Dec. 1999. Epidemiological aspects of these patients as recorded from case files from the records department and X-ray films 11011I the radiology department, provided information about the fractures. A letter of recall of these patients was sent out using the addresses in the files [or an appointment in the orthopaedic clinic where the outcome of the management offered was assessed. A time period of six weeks was allowed for the patients to avail themselves for inclusion into the study from the time the letters were dispatched. The information included prevalence, sex, age, causes, sites of injuries, and type of fracture of the hand skeleton. The mode of management offered and both the degree of functional recovery attained then and possible complications were also assessed. A total number of 203 case files were retrieved with adequate data to be included into the study. Age range was 4 years to 59 years. Seventy two percent were males and the rest were females. The right hand was involved 61.6% of the time. The most frequent cause was assault, 37.4%, followed by work related injuries, 29%. Fifty percent were open fractures. Most of the hands had a single Fracture, 63%. Metacarpals had 51% of the fractures followed by the proximal phalanx, 32%. The middle phalanx was the least fractured. The 51h metacarpal was the most vulnerable of the metacarpals with the 4th Me the least fractured. The 4th proximal phalanx was the most fractured, 33% of the proximal phalanges; the 2nd middle phalanx 55% of the middle phalanges, while the third distal phalanx sustained 47.6% of the distal phalangeal fractures. Most fractures occurred in the diaphyseal region of the bones, 44.9%; the distal joints were involved more frequently compared to the proximal joints. Fifty seven percent had transverse fractures. Out of 203 patients, only 74 patients (36.5%) were recruited into study on outcome. The mean range of duration since injury was 54 weeks. Ninety percent had been managed conservatively but only 54% had gone through some form of rehabilitative programme thirty five percent of the patients were unhappy with the outcome. Fifty nine percent had some degree of stiffness with only 28%-38% able to perform some acceptable degree of fine movement and activities. Sixty nine percent were unable to achieve their full power grip. Sixty six percent had various degrees or malunion