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George AR, Dragan Z, Abbot H, Handford C, Graham DJ, Sivakumar B. Metacarpal Fracture Fixation with Intramedullary Screws. J Hand Surg Asian Pac Vol 2024; 29:217-224. [PMID: 38726490 DOI: 10.1142/s2424835524500231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background: Intramedullary screws (IMS) have become a viable option for metacarpal fracture fixation. To further appraise their utility, this study assessed clinical and patient-reported short- and medium-term outcomes of IMS fixation for extra-articular metacarpal fractures. Methods: A retrospective cohort study was performed in a series of 32 patients (with a total of 37 fractures) who underwent metacarpal fracture fixation over a 42-month period between January 2020 and July 2023. Results: Mean time for return to work was 39.8 days; mean time for return to full function was 88.4 days; total active motion was 250.7° (range: 204.9-270.9); Quick Disabilities of the Arm, Shoulder and Hand score was 2.3 (range: 0-22.7); mean visual analogue pain score was 0.9 out of 10 (range: 0-6) and a single complication was observed. Conclusions: The use of IMS in metacarpal fracture fixation is a practicable surgical option. IMS fixations yields a satisfactory duration for return to function, good postoperative range of movement, modest pain scores and low rates of complications. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Adam R George
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Zac Dragan
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Hagen Abbot
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Cameron Handford
- Department of Orthopaedic Surgery, St George Hospital, Gray St Kogarah, NSW, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - Brahman Sivakumar
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
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Siriwittayakorn W, Adulkasem N, Sangthongsil P, Pitiguagool W, Atthakorn W, Watatham K, Siritattamrong W. Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization. Adv Orthop 2023; 2023:1439011. [PMID: 37877095 PMCID: PMC10593546 DOI: 10.1155/2023/1439011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
Objective This study aims to evaluate the outcomes of single intramedullary K-wire fixation in nonthumb, metacarpal shaft fractures with immediate postoperative hand mobilization without any immobilization. Method This is a retrospective case series conducted from January 2019 to December 2022. We included patients with closed, simple transverse, or short oblique metacarpal shaft fracture treated with single, 1.4 mm, intramedullary K-wire fixation. Gentle postoperative range of motion exercise was encouraged in every patient without any hand, finger, or wrist motion restriction material. Clinical outcomes were evaluated with total active flexion; grip strength; disability of arm, shoulder, and hand (DASH) score; and the American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. Results This study included 34 patients, 25 males and 9 females with a mean age of 33.14 years (ranging 18-59). A total of 43 metacarpal shafts were treated. The mean DASH score at two and 6 weeks postoperative was 41.5 (ranging 19.16-60.34) and 9.58 (ranging 0.83-23.27). The mean final DASH score at last follow-up was 3.48 (ranging 0-8.33). Mean TAF at 2 weeks postoperative, 6 weeks postoperative, and at final follow-up was 203.8 (ranging 185-240), 238.2 (ranging 220-270), and 259.25 (ranging 240-270) degrees, respectively. The mean grip strength of the injured hand was 66.14 and 86.1% of the uninjured hand at 6 weeks and 3 months postoperative. There was no nonunion, malrotation, or infection. In conclusion, single intramedullary K-wire fixation gives excellent outcomes in the treatment of single or multiple, simple, metacarpal shaft fractures without the need of postoperative immobilization.
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Affiliation(s)
| | - Nath Adulkasem
- Department of Orthopaedics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | | | | | | | - Kraisong Watatham
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Haddad E, Zemour M, Belkacemi Y, Al Khoury Salem H, Dohin B. L-pinning for fifth metacarpal neck fracture in adolescents. Orthop Traumatol Surg Res 2022; 108:102992. [PMID: 34186217 DOI: 10.1016/j.otsr.2021.102992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpals. The present study aimed to assess L-pinning without postoperative immobilization in displaced 5th metacarpal fracture in adolescents with low residual growth. MATERIALS AND METHODS Data for patients aged between 13 and 16 years, operated on for closed 5th metacarpal neck fracture between January 2017 and June 2019, were analyzed retrospectively. Surgery was indicated for angulation with>30° palmar tilt and/or horizontal malalignment. The technique consisted in intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpal heads. No postoperative immobilization was applied. Hardware was removed as of day 28. The final clinical check-up was at≥12 months. RESULTS Eighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm2. At hardware removal, all patients showed radiologic consolidation. At 3 months, 5th ray ranges of motion were normal, with no local complications. Functional results were maintained at last follow-up (≥12 months). CONCLUSION L-pinning seemed reliable in terms of feasibility and stability of reduction in 5th metacarpal neck fracture in adolescents. Absence of postoperative immobilization facilitated self-rehabilitation and accelerated functional recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elie Haddad
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France.
| | - Marion Zemour
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Yacine Belkacemi
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Hassan Al Khoury Salem
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Bruno Dohin
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France; LIBM (Laboratoire Interuniversitaire de Biologie du Mouvement, Université Jean Monnet, Université de Lyon.), Saint Etienne, France
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Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskelet Disord 2021; 22:546. [PMID: 34130660 PMCID: PMC8204464 DOI: 10.1186/s12891-021-04436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04436-w.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.,Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Jian Wang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - De-Hua Zhang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Feng Mao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Yi Liao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
| | - Rui Xiao
- Department of Surgical Center, Karamay Central Hospital of Xinjiang, 834000, Karamay, China. .,Karamay District Center for Disease Control and Prevention , 834000, Karamay, China.
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Zeng L, Zeng L, Miao X, Chen Y, Liang W, Jiang Y. Single versus dual elastic nails for closed reduction and antegrade intramedullary nailing of displaced fifth metacarpal neck fractures. Sci Rep 2021; 11:1778. [PMID: 33469102 PMCID: PMC7815815 DOI: 10.1038/s41598-021-81242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/29/2020] [Indexed: 11/09/2022] Open
Abstract
Closed reduction and internal fixation with antegrade intramedullary nails is a feasible and effective treatment for displaced fifth metacarpal neck fractures (FMNFs). The present study aimed to compare clinical and radiological outcomes in patients with displaced FMNFs after treatment with single or dual antegrade elastic intramedullary nails (AEIMNs). Thirty-three patients were treated with a single 2.0 mm AEIMN and 34 patients were treated with two 1.5 mm AEIMNs. Clinical and radiological outcomes included grip strength, active range of motion (ROM), active flexion and extension of the fifth metacarpophalangeal (MCP) joint, dorsal angulation loss, and metacarpal shortening of the fifth metacarpal at 12 months after treatment. No significant difference was observed between the two groups with respect to grip strength, ROM or flexion of the fifth MCP joint. The average values of dorsal angulation loss, metacarpal shortening, and extension of the fifth MCP joint of the dual nails group were better than those of the single nail group (dorsal angulation loss, 2.79 ± 1.93° vs. 4.05 ± 1.59°, P = 0.009; metacarpal shortening, 1.66 ± 0.80 mm vs. 2.12 ± 0.88 mm, P = 0.028; extension of the fifth MCP joint, 7.71 ± 4.43° vs. 4.82 ± 4.09°, P = 0.012). In conclusion, dual AEIMNs fixation provided better MCP extension and radiological outcomes than single AEIMN fixation.
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Affiliation(s)
- Langqing Zeng
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Lulu Zeng
- Department of Anesthesiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Xiaogang Miao
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Yunfeng Chen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weiguo Liang
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Yuwen Jiang
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China.
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