A systematic review and meta-analysis of dynamic external fixation for intra-articular fractures of the hand.

Abstract

A consolidated review of the dynamic external fixation (DEF) technique for intra-articular hand fractures is not available. A systematic review following the PRISMA guidelines included studies on clinical outcomes of DEF for intra-articular hand fractures. A total of 88 studies published between 1978 and 2024 were included with 1357 patients (average age: 36.4 years) and information on 1355 finger fractures was available. The ring finger (30.8%) and proximal interphalangeal joint (PIPJ) (86.8%) were the most affected. Among the known injury mechanisms, sport-related causes were the most frequent (27.3%). Four DEF device classes were identified: commercial, early DEF, pins and rubbers traction system (PRTS), and other Kirschner-wire (K-wire) fixations. Across all studies, only eight cases of deep infection were reported (0.6%). The average trauma to surgery time was 18.1 days, and devices were removed, on average, 35.9 days after implementation. Grip strength was 85.2% of the contralateral, uninjured side for 333 patients. PIPJ range of motion (ROM) averaged 79.3° (n = 1077), with early DEF being the highest (89.4°) and commercial being the lowest (71.7°) (p < 0.001). Pain at last follow-up was 19% (n = 970, QM p = 0.15) and patient satisfaction was 90% (n = 420, QM p = 0.11). There was no difference between device classes for radiological outcomes or complications except for pin-tract infection, with a total estimated prevalence of 147 per 1000 cases (Commercial: 110, Early DEF: 56, and Other K-wire: 151, PRTS: 189, I² = 23.6%, QM p = 0.005). DEF achieves radiological union in an estimated 95% of patients with 90% satisfaction rate.