الفهرس 
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Abstract
The present study during the period from October 2014 to October 2015 at Sohag University Hospital. Inlde 24 fractures at different levels were seen in 20 patients. There were 14 males (70%) and 6 females (30%) divided in two groups , first one include 10 patients with 13 metacarpal fractures treated by K-wires and second group include 10 patients with 11 metacarpal fractures treated by miniplates .
Our aim was to treat these fractures By open reduction and internal fixation by miniplates and open reduction and internal fixation or closed reduction and internal fixation by K-wires to assess functional outcome of each one.
The K-wire group contained larger proportion of patients with first metacarpal fractures but miniplate group contained larger propotion of patients with second metacarpal fractures .
The major causes of fracture in this study was falling of heavy object (90%) , the other were due to direct assault (10%). left side fracture constitute majority of the patients (65%), the predominant metacarpal fracture pattern was transverse (54.2%), majority of fracture occurred at metacarpal shaft (70.8%) in the present study. In this study most of the cases were only one metacarpal bone fractures (66.6%), but (33.3%) had two metacarpal bone fractures .
Routine investigations were done for all patients. All patients were evaluated clinically and radiographically to assess type of injuries. X ray was taken in two planes, anteroposterior and oblique views .
Just before surgery we did the following after Preparation of whole extremity:
- Written and informed consent.
- IV antibiotics half an hour before surgery.
In miniplate group ; metacarpal fractures were exposed through a direct incision made on the radial border of the first and second metacarpals and the ulnar border of the fifth metacarpal. The third and fourth metacarpals were exposed by a longitudinal incision between these two bones. The fracture was anatomically reduced by means of small bone clamps to maintain the reduction.
In K-wire group ; open reduction and internal fixation as in miniplate group or closed reduction and internal fixation were done .The fixation with kirschner wires is a useful technique that is relatively easy to perform and useful in many types of fractures (unstable neck, long oblique). These are typically crossed or inserted in parallel. The transfixing wires should be inserted with the metacarpophalangeal joints flexed to prevent intrinsic muscle tightness . Two wires are necessary distal to the fracture site. This prevents rotation to the distal fragment on a single wire. However, Kirschner wires do not provided truly rigid fixation, and a period of immobilization must always follow to avoid loss of reduction.
The mean total surgical time was 37 minutes (range, 25-60 minutes) for the K-wire group and 51 minutes (range 35-70 minutes) for the miniplate group .
The K-wire group achieved union in 9 out of 10 (90%) patients and the miniplate group achieved union in 10 out of 10 (100%) patients
The average time to radiological union was 12 weeks (range, 8-20 weeks ) in the K-wire group and 12 weeks (range, 8-20 weeks ) in the Miniplate group .
Active range of motion in miniplate group was more than K-wire group in all fracture categories .
The miniplate biomechanically is one of the most effective tools available to the surgeon. It can even resist to failure load of intact bone . For an intimate fit, the plates must be contoured before fixation with the screws. Miniplates provide sufficient stabilization so that motion can be started immediately.
K-wire is less rigid than miniplate, which tends to slide through bone and loosen.
More important is the implant’s fatigue failure properties in response to cyclic stress.
In our study indicated that the miniplate fixation was more suitable than the K-wire fixation for the treatment of metacarpal fractures .