A comparative study of clinical and functional outcome between K-Wire and jess for fixation of extra articular metacarpal fractures

Objectives This prospective randomised controlled study was done to compare the functional outcome following either K-wire or Joshi’s external stabilisation system (JESS) fixation of extraarticular metacarpal fractures. Metacarpal fractures are one of the common fractures of hand following trauma. They comprise around 18–44% of all hand fractures. Metacarpal fractures can be treated conservatively or surgically based on the severity, location, or type of fracture. Conservative management often leads to complications like malunion, nonunion or stiffness compared to surgical fixation. Various modes of fixation like Kirschner-wire, JESS, and mini external fixation have been used. While metacarpal fractures can be treated conservatively, there is a need for surgical fixation in order to prevent complications. Proper preoperative planning and implant selection should be done. The fixation should be rigid enough to start early mobilisation to prevent stiffness, ultimately leading to a good functional outcome. This prospective randomised controlled study was done to compare the functional outcome following either K-wire or JESS fixation of extraarticular metacarpal fractures. Material and Methods 34 patients were allocated into 2 groups. Group A (17 patients) underwent K-wire fixation, and Group B (17 patients) underwent JESS fixation. Functional outcome was assessed with parameters such as total active movement using the American Society for Surgery of Hand (ASSH) scale, quick disabilities of the arm, shoulder and hand (qDASH) score and visual analogue scale (VAS) score. Student t -test, Wilcoxon test, Fishers exact test, and Chi-squared test were used to compare the outcomes. Results At the end of six months, patients treated with JESS had better total active motion by the American Society for surgery of hand (TAM-ASSH) score, qDASH score, and VAS scores compared to K-wire fixation group. Conclusion JESS fixation showed better statistical and functional outcomes compared to K-wire fixation. Due importance should be given on regular pin tract dressings and effective and early postoperative mobilisation to prevent stiffness.