The results of operative treatment of fractures of the thumb metacarpal base.

The results of operative treatment of 21 patients with intraarticular fractures of the thumb metacarpal bone are presented. In 14 patients closed reduction was performed followed by percutaneous fixation with one or two K-wires through the metacarpal shaft to the trapezium. In five delayed cases, in which closed reduction was unsuccessful, open reduction and K-wire pinning was performed. After operation the hand and wrist were immobilized for four weeks. In two patients with Rolando-type fractures, an external fixator was used after closed reduction. Patients were followed-up for six months to three years (mean 1.5 years). Consolidation of fractures was achieved in all cases. Fourteen patients had no pain in the hand at final assessment, two complained of mild pain after activity, and another five complained of pain related to the weather. Grip strength of the affected hand ranged from 72% to 85% (mean 80%) of the expected standard value, matched for gender, age and dominant side. Full opposition of the thumb was achieved in all patients. Self-evaluation of the function of the hand expressed on an analogue scale, from 1 (normal hand function) to 5 (total disability), was from 1.1 to 1.5 (mean 1.2). Abduction of the affected thumb measured on x-ray ranged from 30 degrees to 50 degrees and it was 5 degrees-12 degrees less than in the unaffected hand. Secondary degenerative changes seen as narrowing of the trapeziometacarpal joint were observed in 16 patients. All patients returned to their previous occupations, among them five to hard manual work. None reported problems in daily activities. Our results suggest that closed reduction followed by percutaneous K-wire pinning is a valuable method of treatment for acute fractures. When treatment has been delayed an open operative approach should be considered.