الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The hand is a delicate and sensitive organ that requires both flexibility and stability in order for optimal function. Metacarpal fractures represent a considerable burden upon society in terms of medical costs and reduced workplace productivity, so minimizing the functional loss that may occur following injury is important not only in terms of the patient’s quality of life but also to minimize the overall cost to society. Every injury is unique, and treatment must be tailored to the injury, the patient and the skill of the treating physician. With the advances in processes technology, many different modalities are used for surgical management of metacarpal fractures such as percutaneous K-wire fixation, Interfragmentary screws, Plate fixation tension band wiring, intramedullary fixation and external fixation. Each method has different indications and outcomes. In our study we had forty five case subdivided into three groups of fifteen patients each, a conservative group, a closed reduction with percutaneous pinning fixation group and an open reduction with internal fixation using plates and screws group. We analyze the outcomes by assessment of both the clinical and radiological union within six weeks and by assessment of the range of motion using a goniometer, grip strength using Jammar dynamometer, the visual analogue scale score at six and twelve weeks ,The Disabilities of arm, shoulder and hand score each at twelve weeks only. Most metacarpal fractures will unite with conservative measures as immobilization in a slap or a cast, so the overriding aim of surgical intervention is to restore function to the hand by maintaining joint mobility and stability and to avoid the two most prevalent squeal of conservative treatment : stiffness and deformity. The results shows that the different modalities have no effect on the outcome on the long term, while the ORIF on the short term has more effect on the time of clinical union, time of early movement and starting activity and both the grip strength and ROM, but using CRPP has an effect on the VAS score and more infection complications occurred within this group. All modalities used have no effect on both radiological union and the DASH score. Metacarpal base fractures are best fixed with K-wires. Transverse and short oblique metacarpal shaft fractures are best fixed with plates and screws. Long oblique metacarpal shaft fractures are best fixed with screws. Comminuted fractures are best treated with mini external fixation with or without bone grafting. Metacarpal neck fractures are best fixed with transverse K-wires through the adjacent metacarpal. Metacarpal head fractures are best treated with screws. Bennett and Rolando fractures are common intra-articular first metacarpal base fractures. They are best managed through ORIF with K-wires or screws. External fixation may be needed. Rehabilitation is the key to success. After the fracture is stabilized by whatever means, continuous passive followed by active assisted and strengthening exercise should be instructed by trained physiotherapist.