A RURAL PERSPECTIVE ON THE MANAGEMENT OF PHALANGEAL & METACARPAL FRACTURES USING MINI EXTERNAL FIXATORS/JESS - A PROSPECTIVE STUDY

Abstract

Hand fractures, including phalangeal and metacarpal injuries, are among the most prevalent yet often overlooked skeletal injuries. This study evaluates the use of mini-external fixators/ JESS for stabilizing such fractures, focusing on functional outcomes in a rural tertiary care setting. A prospective, non-randomized study involving 34 patients highlights the effectiveness of these devices in achieving stable fracture fixation and promoting early mobilization.
 
Introduction: The human hand, with its unparalleled functionality, is vulnerable to a variety of injuries, especially in rural environments where agricultural and occupational hazards are common. Fractures of the metacarpals and phalanges constitute 13 %- 15% of hand injuries, often necessitating surgical intervention for complex cases. External fixation offers minimal surgical trauma, preservation of fracture hematoma, and simplified post-operative care, making it a viable option for rural healthcare setups.
 
Materials and Methods: This eight month study (in the year August 2023 - April 2024) involved 34 patients aged 18–40 with phalangeal and metacarpal fractures. The study was conducted after ethical clearance, patients were included into them study depending on the inclusion & Exclusion criteria. The fractures were stabilized using threaded K-wires, clamps, and connecting rods, with reductions achieved under C-arm guidance. Post-operative follow-ups were conducted to monitor infection, alignment, and functional outcomes.
Results: Of the 34 patients, 23 were male and 11 female. Most injuries (63%) were open fractures, with agricultural accidents being the leading cause. Fractures included 43% proximal phalanx, 25% metacarpals, and 32% middle phalanx. Union was achieved in 79% of cases, while delayed union occurred in 21%, primarily due to infection or bone loss. Outcome assessments revealed 49% excellent, 27% good, 17% average, and 6% poor results. Complications included pin tract infections and fracture angulation, which were managed with appropriate interventions.
 
Discussion: External fixation proved particularly effective for extra-articular fractures, which showed better functional outcomes compared to intra-articular fractures. The use of threaded K-wires and mini-external fixators/ JESS allowed early joint mobilization, crucial for restoring hand function. However, intra-articular fractures often led to joint stiffness, affecting recovery. Comparisons with previous studies validate these findings, emphasizing the method's simplicity and efficacy.
 
Conclusion: Mini-external fixators/JESS offer a practical, efficient solution for managing phalangeal & metacarpal fractures in rural settings. They ensure stable fixation, promote soft tissue healing, and allow early mobilization, yielding favorable functional outcomes despite minor complications. The technique is cost-effective, with a short learning curve, making it ideal for resource-constrained environments.