USE OF THE MINICONDYLAR PLATE IN METACARPAL AND PHALANGEAL FRACTURES

The minicondylar plate is used for unstable intraarticular and periart icular fractures of the phalanges and metacarpals to provide stability and to allow early motion. This low profile implant carl he placed la terally to avoid injury to the extensor mechanism, Tile authors retros pectively reviewed 53 consecutive patients from 2 institutions in whom 68 fractures (41 metacarpal and 27 phalangeal) had been treated with 1.5-mm or 2-mm minicondylar plates. Common mechanisms of injury were g unshot wounds, crush injuries, and assalut/beatings. Thirty-seven frac tures were open, 19 had severe soft tissue injury, and 30 required and bone graft. The followup period averaged 17 months. There were no non unions or malunions. Sixty-seven complications were associated with 40 fractures in 29 patients: primarily symptomatic plates or pullout (30 complications), extensor lag (13 complications), and infections (8 co mplications). The complication rate was significantly higher in intraa rticular and periarticular fractures also involving the middle 1/3 ver sus proximal 1/3 fractures; open versus closed fractures; fractures wi th increased soft tissue injury versus minimal injury; and bone grafte d versus nongrafted fractures. Final are of total active motion, avail able for 45 fractures, was excellent (greater than or equal to 221 deg rees) for 17 fractures; good/fair (121 degrees to 220 degrees) for 15, and poor (less than or equal to 120 degrees) for 13, Metacarpal fract ures had a significantly higher percentage of excellent results than d id phalangeal fractures, Final motion did not correlate significantly with complication rate, severity of soft tissue injury location in the bone, open versus closed fracture, or use of bone graft, When fractur es cannot he restored and stabilized reliably by less invasive methods , the minicondylar plate provides secure fixation and call result in a dequate function, even in the presence of severe combined injuries.