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Seaton D, Sidhu G, Kitsis C, Ashwood N. Open Reduction and External Fixation of a Comminuted Intra-articular Fifth Metacarpal Head Fracture: A Case Report. Cureus 2023; 15:e38845. [PMID: 37303336 PMCID: PMC10255934 DOI: 10.7759/cureus.38845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Comminuted intra-articular fractures are among the most difficult to fix, with open reduction and internal fixation often being impossible. We report the case of a 15-year-old male who required an open reduction with external fixation after sustaining an extremely comminuted intra-articular fifth metacarpal head fracture of the right hand. The patient presented with swelling localised to the fourth and fifth dorsal metacarpals of the right hand, with radiographs demonstrating an intra-articular fracture with comminution and articular surface depression. Literature surrounding metacarpal head fractures, although scarce, suggests that whilst treatment must be individualised, most osteochondral fractures can be managed via open reduction with internal fixation either via K wires, interfragmentary screws or small headless screws. This case demonstrates that in challenging cases, with limited bone stock and cavities created through reduction of the fracture, fixation can be achieved through K wire with HK2 external fixation. It also highlights the apparent insufficiency in articles specifically detailing potential management options for intra-articular metacarpal fractures and has provided evidence of one potential fixation method.
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Affiliation(s)
- David Seaton
- Trauma and Orthopaedics, University of Leicester Medical School, Leicester, GBR
| | - Gur Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Christos Kitsis
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, Wolverhampton University Research Institute, Wolverhampton, GBR
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Chughtai M, Scollan JP, Emara AK, Brej B, Steckler A, Churchill JL, Ferre A, Saluan P, Styron JF. The "Fight Bite" Saline Joint Loading Test: Effectiveness in Detecting Simulated Traumatic Metacarpophalangeal Arthrotomies. Hand (N Y) 2022:15589447211068184. [PMID: 34991409 DOI: 10.1177/15589447211068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The saline load test is routinely used to recognize other joints' traumatic arthrotomies; however, there are currently no studies evaluating the novelty of this test for metacarpophalangeal joints (MCPJs). This study aimed to investigate the effectiveness and sensitivity of saline load testing in identifying the traumatic arthrotomies of the MCPJs using human cadavers. Methods: This was a cadaveric study of 16 hands (79 MCPJs). Traumatic arthrotomies were created using 11-blade stab-incisions, followed by blunt probing into the joint on the radial or ulnar side of the flexed MCPJs. A 3-mL syringe was used to inject intra-articular methylene-blue-dyed saline from the contralateral side. The volume at saline extravasation was recorded. Test sensitivity and factors influencing extravasation volume were assessed. Results: The mean (range) volume injected to identify arthrotomy of all MCPJs was 0.18 mL (0.1-0.4 mL). The mean volume to identify MCPJ arthrotomy of the thumb, index, long, ring, and small fingers was 0.16 mL (0.1-0.3 mL), 0.19 mL (0.1-0.3 mL), 0.21 mL (0.1-0.4 mL), 0.17 mL (0.1-0.3 mL), and 0.16 mL (0.1-0.3 mL), respectively. Cadaver age, laterality, and joint range of motion were not significantly associated with the injected volume at extravasation(P > .05, each). Injection volumes of 0.3 and 0.32 mL were required to detect arthrotomies at 95% and 99% sensitivities across all MCPJs. None of the MCPJs required > 0.4 mL to detect arthrotomy. Conclusions: Saline joint loading volumes to detect traumatic arthrotomy were similar for all MCPJs. Injection volumes of 0.32 mL is suggested for 99% sensitivity. Our findings provide the first report, to our knowledge, on intra-articular injection volumes expected to detect an arthrotomy of MCPJ. This is critical for further validation using in vivo clinical studies.
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Affiliation(s)
| | | | | | - Ben Brej
- Cleveland Clinic Foundation, OH, USA
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Blackburn J, Armstrong D. Fixed dental brace band in a fight bite injury: a case report. J Hand Surg Eur Vol 2020; 45:308-309. [PMID: 31818179 DOI: 10.1177/1753193419892561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e32933. [PMID: 27800460 PMCID: PMC5078834 DOI: 10.5812/atr.32933] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT Hand injuries are a common emergency department presentation. Metacarpal fractures account for 40% of all hand fractures and can be seen in the setting of low or high energy trauma. The most common injury pattern is a metacarpal neck fracture. In this study, the authors aim to review the surgical indications for metacarpal neck fractures, the fixation options available along with the risk and benefits of each. EVIDENCE ACQUISITION Literature review of the different treatment modalities for metacarpal neck fractures. Review focuses on surgical indications and the risks and benefits of different operative techniques. RESULTS The indications for surgery are based on the amount of dorsal angulation of the distal fragment. The ulnar digits can tolerate greater angulation as the radial digits more easily lose grip strength. The most widely utilized fixation techniques are pinning with k-wires, dorsal plating, or intramedullary fixation. There is currently no consensus on an optimal fixation technique as surgical management has been found to have a complication rate up to 36%. Plate and screw fixation demonstrated especially high complication rates. CONCLUSIONS Metacarpal neck fractures are a common injury in young and active patients that results in substantial missed time from work. While the surgical indications are well-described, there is no consensus on the optimal treatment modality because of high complication rates. Dorsal plating has higher complication rates than closed reduction and percutaneous pinning, but is necessary in comminuted fractures. The lack of an ideal fixation construct suggests that further study of the commonly utilized techniques as well as novel techniques is necessary.
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Affiliation(s)
- Eric M. Padegimas
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
- Corresponding author: Eric M. Padegimas, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 516 College, Philadelphia, USA. Tel: +1-2159551500; +1-8606040902, Fax: +1-2155030530, E-mail:
| | - William J. Warrender
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Christopher M. Jones
- Department of Orthopedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, USA
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Shewring DJ, Trickett RW, Subramanian KN, Hnyda R. The management of clenched fist 'fight bite' injuries of the hand. J Hand Surg Eur Vol 2015; 40:819-24. [PMID: 25770897 DOI: 10.1177/1753193415576249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/12/2015] [Indexed: 02/03/2023]
Abstract
We present a prospective study outlining the management of clenched fist 'fight bite' injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries. The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes. A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.
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Affiliation(s)
- D J Shewring
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - R W Trickett
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - K N Subramanian
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - R Hnyda
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
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Malahias M, Jordan D, Hughes O, Khan WS, Hindocha S. Bite injuries to the hand: microbiology, virology and management. Open Orthop J 2014; 8:157-61. [PMID: 25067969 PMCID: PMC4110396 DOI: 10.2174/1874325001408010157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Bites to the human hand, be it from a pet, a stray animal or even a fellow human, may often have dire consequences for the person suffering the insult. Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms, in the UK. Clenched fist injuries to the mouth ('fight bite') are notorious for being the worst human bites. Bite injuries of the hand and their related infections must be monitored vigilantly and managed proactively, by experts in this field of surgery. In this review article we discuss the associated microbiology and virology of these injuries as well as their management.
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Affiliation(s)
- M. Malahias
- Plastic Surgery Department, Good Hope Hospital, West Midlands, B75 7RR, UK
| | - D. Jordan
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - O. Hughes
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - Wasim S. Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
| | - S. Hindocha
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
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Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in managing fractures of metacarpal and phalangess. Indian J Plast Surg 2011; 44:203-11. [PMID: 22022030 PMCID: PMC3193632 DOI: 10.4103/0970-0358.85341] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon's work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.
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Affiliation(s)
- Jagannath B Kamath
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal University, India
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9
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Smith BA. Dorsal hand laceration and swelling. Acad Emerg Med 1995; 2:41-2, 68-70. [PMID: 7606611 DOI: 10.1111/j.1553-2712.1995.tb03080.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B A Smith
- Department of Emergency Medicine, Joint Military Medical Centers Emergency Medicine Residency: Wilford Hall Medical Center, San Antonio, TX, USA
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Beevers DJ, Seedhom BB. Metacarpophalangeal joint prostheses: a review of past and current designs. Proc Inst Mech Eng H 1993; 207:195-206. [PMID: 7802870 DOI: 10.1243/pime_proc_1993_207_297_02] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The anatomy and biomechanics of the metacarpophalangeal (MCP) joint are briefly described. Hinge, flexible and surface designs of past and current MCP prosthetic joints are reviewed, outlining their respective advantages and disadvantages. Although existing prostheses can restore cosmetic appearance and relieve pain, none can equal the stability and versatility of the natural joint. Delayed reconstructive surgery may be partly responsible for the mediocre results experienced, since the later the surgery the worse will be the condition of the muscles and ligaments surrounding the joint. These are the structures responsible for strength, movement and stability of the joint. From a mechanical viewpoint it may be desirable to operate at an earlier stage of the disease than is currently indicated, but this is a clinical decision. Some design aspects, namely fixation and wear, require a different approach when designing an MCP prosthesis from that adopted in the case of prosthetic hips and knees.
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Affiliation(s)
- D J Beevers
- Rheumatology and Rehabilitation Research Unit, University of Leeds
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