Abstract / Summary
The junctura tendinum (JT) are interconnecting bands between the extensor digitorum communis tendons on the dorsum of the hand. During dorsal plate fixation of metacarpal shaft fractures, these structures may need to be divided for adequate exposure, yet whether their transection and repair affects hand function is unknown. This study compared outcomes between JT transection and repair and JT preservation during plate fixation of these fractures. We retrospectively reviewed 71 patients who underwent open reduction and plate fixation of a single metacarpal shaft fracture, divided by intraoperative JT management into transection and repair (39 patients) and preservation (32 patients). The primary outcome was total active motion (TAM) at the sixth postoperative month; secondary outcomes included grip strength, %TAM and %grip strength relative to the contralateral uninjured hand, Quick-DASH score, radiological outcomes, operative time, and complications. Between-group comparisons were additionally adjusted for fracture comminution. The groups were comparable in age, sex, body mass index, and hand dominance. TAM (279.6 vs. 282.1 degrees, p = 0.28), %TAM (97.2 vs. 98.1%, p = 0.29), grip strength (44.8 vs. 42.1 kg, p = 0.25), %grip strength (93.4 vs. 94.8%, p = 0.57), and Quick-DASH scores (1.5 vs. 0.7, p = 0.20) did not differ significantly. Time to union (6.4 vs. 6.1 weeks, p = 0.31) and overall complication rates (20.5% vs. 12.5%, p = 0.53) were also comparable, and differences remained non-significant after adjustment for fracture comminution (adjusted odds ratio for complications 1.45, 95% CI 0.36 to 5.89). The only significant difference was a longer operative time in the transection and repair group (52.4 vs. 43.1 min, p = 0.01). In this retrospective cohort, no superiority of either approach was demonstrated in functional, radiological, or complication outcomes at six months, although transection and repair required a longer operative time. Because the study was not designed as an equivalence or non-inferiority trial, equivalence cannot be concluded. Nevertheless, when preservation is not feasible, careful transection and repair of the JT appears to be a reasonable option, as it was not associated with worse outcomes in this cohort.