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
Citation
Doctor of philosophy in Medical Surgery, University of Nairobi, 2000.Publisher
University of Nairobi Faculty of Medicine