الفهرس 
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Abstract
Hand fractures represent a considerable burden upon society in terms of medical costs and reduced workplace productivity. Fractures of the metacarpals and phalanges are the most common fractures of the upper extremity. Those fractures are broadly classified into three types: transverse, oblique and spiral, and comminuted. Outcome of conservative treatment in displaced, irreducible, unstable and rotational fractures is poor. Surgical treatment is preferred in this type of fractures. Metacarpal and phalangeal fractures in general can be treated surgically with Kirschner wires, screws or hand plates. Lag screws are the implant of choice for oblique and spiral fractures of the metacarpals and phalanges. In this study range of motion, functional and radiological results of treatment of oblique and spiral metacarpal and phalangeal fractures by open reduction and internal fixation using mini lag screws were evaluated. Thirty five oblique and spiral fractures in thirty hands were included in this study with 23 metacarpal and twelve phalangeal fractures. Eleven spiral and 24 oblique fractures were followed up for 26 to 42 weeks. Gender distributed as four females and 26 males with Patients’ mean age of 29.4 (range 17-54) years old noting that 56.7% of them were manual workers. Mean time lag between the trauma and the surgical procedure was 3.6 (range 1-7) days.
The mean value of TAM score of twelve phalangeal fractures at the end of follow up was 217.5 ± 14.9 (range 190-240). Final range of motion assessment revealed four (33.3%) good and eight (66.7%) excellent results. The mean result of Quick DASH score at the final visit was 12.12 ± 6.21 (range 4.5-29.5). The mean period for radiologic signs of union to appear was 7.51 ± 1.22 (range 5-11) weeks.
TAM score was measured for twelve phalangeal fractures. There was statistically insignificant relation between the score and age, hand dominance, occupation, smoking, mode of injury, intraaricular extension, operative duration, screws number and infection. While there was statistically significant relation between the score and gender, fracture distribution, time lag before surgery and splint duration.
Quick DASH score was measured for 35 metacarpal and phalangeal fractures. There was statistically insignificant relation between the score and age, hand dominance, occupation, mode of injury, intraaricular extension, infection, operative duration and screws number. While there was statistically significant relation between the score and gender, smoking, fracture distribution, time lag before surgery and splint duration.
Durations needed for radiologic signs of union were followed up. There was statistically insignificant relation between the duration and age, gender, hand dominance, mode of injury, fracture distribution, intraaricular extension and screws number. While there was statistically significant relation between the duration and occupation, smoking, infection, time lag before surgery, operative duration and splint duration.
In this study there were three patients suffered from complications in the form of infection. Two of them had phalangeal fractures with postoperative superficial wound infection which were treated by debridement and antibiotics. The other had fourth metacarpal fracture with postoperative deep infection that necessitated implants removal.