Tension band wiring of fractures of the phalanges and the metacarpals

ABSTRACT

The aim of this paper is to describe the technique of tension band wiring of the metacarpals. One hundred unstable closed fractures of metacarpals and phalanges were treated by open reduction and internal fixation using tension band wiring technique. Forty patients had metacarpal fractures and 60 phalangeal fractures. The youngest patient was 16 years old and the oldest 60; mean age was 29.8 years. There were 12 displaced transverse fractures, 38 displaced oblique fractures, 35 displaced spiral fractures and 15 comminuted fractures. The tension band wiring was applied using 0.0889 cm Kirschner wires and 26 - 28 gauge monofilament stainless steel suture. The period of follow up ranged from 6 - 30 months, average of 17.1 months. At the end of follow up, 87 patients achieved excellent results 10 achieved good results and 3 achieved fair results. encountered were superficial infection in 6 patients, tenderness over the fracture site in 21, local pain in 11, stiffness of the fingers in 16, deformity in 5 and non-union in 2. Problems of fixation occurred in short oblique and comminuted fractures. In such cases additional external splintage may be needed. Failure of tension band wiring was found to be due to the use of home-made cut tips Kirschner wires, repeated passage of the wires, improper knotting of the stainless steel sutures, presence of severe comminution and early use of the hands in heavy work before union of the fracture