We read this article with interest. The authors report that plate fixation in closed metacarpal fractures 'is a safe and reliable method of treatment providing predictably good outcome'. . In the authors' opinion, the reported high complication rate (Fusetti et al., 2002; Page and Stern, 1998; Stern et al., 1987) could be due to inappropriate patient selection, failure to apply biomechanical principles, faulty technique, poor soft tissue handling and inadequate functional aftercare. We would like to offer several comments on the basis of our experience in plating metacarpal and phalangeal fractures (Fusetti et al., 2002; Fusetti and Delia Santa, 2004; Kurzen et al., 2006). With the obvious limitations of a small and retrospective series, Souer and Mudgal observed four complications in 18 patients (one patient was lost to the follow-up after 2 weeks) with a complication rate of 22 percent in patients without associated soft tissue injuries.
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