الفهرس 
INTRODUCTION
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Abstract
The aim of this work was to evaluate the results of treatment of unstable spiral and oblique metacarpal fractures by open reduction and internal fixation using mini-set screws versus percutaneous Kirschner wire fixation.
The study included thirty patients presented at El-Hadara University Hospital, Faculty of Medicine, Alexandria University, with thirty seven fractured metacarpals in thirty hands. 15 patients were fixed by open reduction and internal fixation using interfragmentary minist screws (group A), the other 15 patients were fixed by percutanous K wires (group B).
On admission, all patients were assessed by history taking, clinical examination, and radiological assessment.
The mean age of group A was 32.07 ± 9.02 years (range from 19 to 50) while that of groub B was 33.8 ± 10.07 years.
Ten patients were males (66.7%) in group A and five were females (33.3%) ,while in group B twelve patients were males (80%) and three patients were females (20%).
Seven patients were manual workers (43.7%), three were students (20%), three were clerks (20%), two were house wives (13.3%) and two student (20%) in group A, while in group B nine were manual workers (60%), two were students (13.3%), two were clerks (13.3%), two were house wives (13.3%) and two students (13.3%).
Regarding the mode of trauma, eight patients were due to falling down (53.3), five due to alleged assault (33.3%), and two due to road traffic accidents (13.3%) in group A, while in group B four due to falling down (26.7), seven due to alleged assault (46.7%), and four due to road traffic accidents (26.7%).
Each group included 13 patients with single metacarpal fracture, and 2 patients with multiple metacarpal fractures.
Twelve patients were treated within the 1st week of trauma and three patients were treated after the 1st in group A, while in group B all patients were treated within the 1st week.
After a follow up period of four months, the data gained from analysis of information obtained from the patients subjectively, objectively, and radiologically were evaluated, processed, and tabulated.
The final results were assessed according to a modified DASH scoring system:
DASH score after 4 months of follow up were excellent in twelve patients (80%), good in two patients (13.3%), and poor in one patient (6.7%) in group A, while in group B were excellent in eleven patients (73.3%), good in three patients(20%), and fair in one patient (6.7 %).
There was no significant statistical relation between the results in metacarpal fractures and the age, sex, occupation, and method of fixation.
Patients treated by percutaneous K-wires were found to give better results with lapse of time after operation specially regarding the range of motion and hand grip.
There was no significant statistical relation between method of fixation and fracture union in both groups.
Regarding the hand grip, twelve patients had strong hand grip (80%), two patients had average hand grip (13%), one patient had weak hand grip (6.7%) in group A, while in group B , ten patients had strong hand grip (66.7%), three patients had average hand grip (20%), two patients had weak hand grip (13.3%).
The final results were satisfactory in (93.3%) and not satisfactory in (6.7%) in each group.
The complications encountered in this work were; Group A: one case of nonunion, one patient had superficial wound infection (stitch sinus) that was treated by wound debridment, and proper antibiotics. Group B: three patients had pin tract infection at the site of exit of K-wires, which resolved completely after removal of K-wires and sensitive antibiotics, one patient with ≤ 10˚ of dorsal angulation, four patients with less than 2 mm shortening, two patients had mild rotation. All these findings were considered as mild deformities that did not cause any effect.