Vol. 10, Issue 3 (2024)

Introduction: Fractures of the bones in the hand are among the most frequent types of fractures in the extremities. This category includes fractures of the metacarpals and phalanges in the hand, as well as fractures of the metatarsals and phalanges in the foot. Effective treatment for fractures is determined by various factors, including the fracture's location (whether intra-articular or extra-articular), its pattern (such as transverse, spiral, oblique, or comminuted), and any resulting deformities (like angular, rotational, or shortening). Additional considerations include whether the fracture is open or closed, the presence of associated soft tissue injuries, and the fracture's stability.

Methods: From August 2023 to July 2024, a total of 40 cases of metacarpal and phalangeal fractures of the hand were treated with JESS Ex-fixator or K – wire fixation. All patients were screened using inclusion and exclusion criteria. Follow up was done till 12 months to evaluate the fracture union and range of movements by American Society for Surgery of the Hand – Total Active Flexion score.

Results: On analysing the results of this study - 27 (67.5%) patients had open fractures and 13 (32.5%) had closed fracture. The gender distribution in this study is 32 (80%) male patients and 8 (20%) female patients. Based on mode of injury there are 17 (42.5%) with RTA, 20 (50%) with work place injuries and 3 (7.5%) with assault as a mode of injury to the hand. According to the ASSH – TAF score JESS –Ex- Fix has an excellent result in managing intra-articular fractures (p value < 0.05). P-value was derived using ANOVA test using TAF scores at the end of 1 month, 1.5 months and 3 months. Whereas the ASSH – TAF scores K – wire fixation has an excellent result in managing shaft fractures. Mean operative time in JESS – Ex Fix is 25.65 +/- 5.07 minutes and in K –wire it is 10.16 +/- 2.34 minutes. Mean implant removal time in JESS – Ex Fix is 5.1 +/- 1.07 weeks and in K –wire it is 5.46 +/- 1.34 weeks. Mean union time in JESS Ex - Fix is 7.65 +/- 2.07 weeks and in K –wire it is 8.46 +/- 2.34 weeks.

Conclusion: JESS Ex-fixation is an adequate alternative treatment for unstable phalangeal and metacarpal fractures which are open or accompanied by severe soft-tissue injuries.