الفهرس 
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Abstract
Metacarpal and phalangeal fractures are common fractures of the upper limb associated with permanent loss of upper extremity dexterity. The bones of metacarpal and phalanges are tubular with collective transverse arches and intrinsic longitudinal arches. Injury from direct blows, axial loading, and torsional loading are the main causes of metacarpal shaft fractures. The metacarpal fractures constitute 18–44% of hand fractures. The superficial presence of the bone and the use of hand for evasive action to trauma make the metacarpals as commonly fractured bones. The metacarpal fracture can be classified depending upon the site as fracture of head, neck, shaft or base of the metacarpal.
Displacement and any neurological and vascular injuries must be treated with early mobilization through open reduction and internal fixation to achieve maximum normal function and anatomy. Early mobilization reduces joint stiffness, edema, and adherence to free normal gliding structures. In every type of fracture, the ultimate goal is to achieve normal motion, but the technique of choice for stabilizing the fracture remains debated.
The management of metacarpal and phalangeal fractures varies among surgeons, and there are no standard guidelines for treatment. Different techniques, such as conservative management, tension band wiring using Kirschner’s wires (K-wires), and plates and screws, can be employed. Each technique has its own factors that need to be considered, and there is ongoing debate regarding the optimal approach for stabilizing the fracture.
Various factors influence the recovery of good mobility in these fractures, including delicate tissue handling, preservation of gliding planes for tendons, prevention of infection, and early and appropriate physiotherapy. Without treatment, deformity can occur, while over-treatment can lead to stiffness, and poor treatment can result in both deformity and stiffness.
In internal fixation, Kirschner wires or miniplates can be used. The use of K-wires offers advantages such as advanced material, minimal dissection, technical ease, and availability. Definitive reduction and fixation can be achieved using the tension band technique, where K-wires are inserted perpendicular to the fracture and passed from proximal to distal. This technique utilizes two K-wires as an internal splint to counteract rotational and angular displacement forces.
Therefore, this study to evaluate and study advantages, disadvantages and complication aspects of management of phalangeal and metacarpal fractures with open reduction and internal fixation with Kirschner wires (K-wires) using tension band wiring technique.
This prospective study was conducted at Benha University Hospitals, including twenty patients with metacarpal and phalangeal fractures. Patients underwent open reduction and internal fixation using the tension band wiring technique with K-wires. Detailed clinical evaluations were performed, including patient demographics, fracture characteristics, mechanism of injury, time lapse before surgery, and comorbidities. Radiological assessments were carried out using standard anteroposterior, lateral, and oblique views. Postoperatively, patients were followed up for a period of 6 months to evaluate fracture healing, alignment, range of motion, and grip strength. Functional outcomes were assessed using the Belsky scoring system, while patient satisfaction and complications were also recorded.
• Summary of our results:
• The patients’ mean age was 35.65 ± 7.98 years. Among the patients, 25% were under 30 years of age, 40% were between the ages of 31 and 40, and 35% were over 40. In terms of gender, 85% of the patients were male, and 15% were female. Males count were significantly higher than females (p=0.002). In terms of comorbidities, 10% of the patients had hypertension, 5% had diabetes, and 85% had no comorbidities.
• According to occupation of patients, the majority of patients were heavy manual workers (60%), 20% were light workers, 10% were students, and 10% were housewives.
• Among the patients, 55% had trauma on their dominant side, while 45% had trauma on their non-dominant side. In terms of the mechanism of trauma, 50% of the patients had direct trauma, while the other 50% had indirect trauma.
• According to the distribution of affected bones, out of a total of 28 fractures, 18 fractures (64.3%) were in the metacarpal bones and 10 fractures (35.7%) were in the phalangeal bones.
• According to fracture pattern, the most common fracture patterns among the affected bones were transverse and spiral fractures, each accounting for 25% of the total fractures. Long oblique and short oblique fractures, each accounting for 18% of the total fractures. The least common fracture pattern is minimally comminuted, accounting for only 14% of the total fractures.
• According to time lapse before operation, the mean time lapse till operation was 4.2 ± 2.7 days. Additionally, 18 of the 20 patients (90%) underwent surgery within one week of their injury, while the remaining 2 patients (10%) underwent surgery more than one week after their injury.
• Out of a total of 20 studied patients, 18 patients (90%) received general anesthesia during their surgery, while the remaining 2 patients (10%) received local intravenous anesthesia.
• According to total active motion (TAM), mean TAM showed a significant increase at 3 months post operation compared to 6 weeks after operation (p=0.008). A significant increase in TAM at 6 months post operation compared to 6 weeks post operation (p<0.001).
• At 6 weeks: 3 patients (17.6%) had an excellent score, 8 patients (47.1%) had a good score, and 6 patients (35.3%) had a poor score. At 3 months, a significant improvement of Belsky score compared to 6 weeks post operation (p=0.023). At 6 months: 12 patients (70.6%) had an excellent score, 4 patients (23.5%) had a good score, and only 1 patient (5.9%) had a poor score with significant improvement compared to 6 weeks post operation (p=0.04).
• At the end of follow up period, no patients complained of pain during usual work.
• According to deformity at the end of follow up period, out of a total of 20 studied patients, 19 patients (95%) did not ha