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Bigorre N. Complications of osteosynthesis for long-finger metacarpal and phalanx fracture. HAND SURGERY & REHABILITATION 2024:101746. [PMID: 38971225 DOI: 10.1016/j.hansur.2024.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/08/2024]
Abstract
Fractures of the metacarpals and phalanges represent a significant proportion of hand fractures. Although non-operative treatment is generally effective, some fractures require surgery. Historically, osteosynthesis using K-wires was widely used, but screw plates and then cannulated intramedullary screws have emerged as therapeutic alternatives. We assessed the complications associated with the different osteosynthesis techniques: stiffness, infection, bone consolidation and hardware-related problems. Each osteosynthesis technique has advantages and disadvantages, and choice depends on several factors. An individualized approach according to patient and fracture is essential to optimize clinical results.
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Affiliation(s)
- Nicolas Bigorre
- Centre de la Main - 47 Rue de la Foucaudière, 49800 Trelaze, France.
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Kwan SA, Moncman TG, Sodha S, Jones C, Matzon JL, Rivlin M. Screw Position Following Percutaneous Versus Mini-Open Intramedullary Retrograde Screw Fixation of Metacarpal Fractures. Hand (N Y) 2024:15589447241241765. [PMID: 38567532 DOI: 10.1177/15589447241241765] [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: 04/04/2024]
Abstract
BACKGROUND Metacarpal fracture fixation using the retrograde intramedullary screw technique can be performed through two different approaches. The mini-open approach requires greater soft tissue dissection but allows for direct visualization of the metacarpal head compared with the percutaneous approach. Our aim was to determine which approach resulted in optimal screw position. METHODS Eighty-one consecutive patients that underwent intramedullary screw fixation for metacarpal fractures from 2016 to 2021 were identified. Patients were treated by 4 fellowship-trained orthopedic hand surgeons who employed the mini-open or percutaneous approach. Postoperative radiographs were reviewed for screw position. RESULTS A total of 81 patients (41 mini-open, 40 percutaneous) were included in this study. There were no significant differences between the two groups in age, sex, hand dominance, or affected digit. Postoperative screw position at first postoperative visit was not significantly different between the two groups on anteroposterior or lateral radiographs. CONCLUSION Postoperative screw position is not significantly different between the mini-open and percutaneous approaches for intramedullary screw fixation of metacarpal fractures. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Stephanie A Kwan
- Department of Orthopaedic Surgery, Jefferson Health, Stratford, NJ, USA
| | - Tara Gaston Moncman
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Samir Sodha
- Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Christopher Jones
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonas L Matzon
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Rivlin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Humar P, Thayer J, Bengur FB, Villalvazo Y, Hu M, Unadkat J. Early Return of Motion in Patients With Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation. Ann Plast Surg 2024; 92:S136-S141. [PMID: 38556662 DOI: 10.1097/sap.0000000000003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns. METHODS This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded. RESULTS There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18-89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0-32) with 32 days (interquartile range, 10-62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics. CONCLUSIONS Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.
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Affiliation(s)
- Pooja Humar
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jacob Thayer
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fuat Baris Bengur
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yadira Villalvazo
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael Hu
- From the Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Hollins AW, Dunworth K, Mithani SK, Pidgeon TS, Klifto CS, Ruch DS, Richard MJ. Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures. Hand (N Y) 2024:15589447241232009. [PMID: 38411093 DOI: 10.1177/15589447241232009] [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: 02/28/2024]
Abstract
BACKGROUND Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures. METHODS A retrospective review was performed at our institution between the years 2018 and 2022 for patients treated for proximal phalanx fractures. Patients that underwent fixation with IM nails or percutaneous fixation for isolated extraarticular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fractures, tendon injury, or intraarticular extension. RESULTS A total of 50 patients were included in this study. Twenty-eight patients received percutaneous pin fixation, and 22 patients underwent IM nail or screw fixation. There was no significant difference in injury patterns or demographics between these two groups. Patients that underwent IM nail fixation had a significantly quicker return to active motion, shorter duration of orthosis treatment, and fewer occupational therapy visits. In addition, patients in the IM fixation group had significantly improved range of motion (ROM) at 6 weeks postoperatively. CONCLUSIONS This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. The IM nail fixation group was able to have quicker return to mobilization, fewer required occupational therapy visits, and improved early ROM.
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Affiliation(s)
- Andrew W Hollins
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kristina Dunworth
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Suhail K Mithani
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tyler S Pidgeon
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Straszewski AJ, Dickherber JL, Conti Mica MA. Articular Involvement With Retrograde Headless Compression Screw Fixation of the Metacarpal. J Hand Surg Am 2024; 49:62.e1-62.e6. [PMID: 35868900 DOI: 10.1016/j.jhsa.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/30/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Retrograde headless compression screw (RHCS) fixation for metacarpal fractures can lead to metacarpal head articular cartilage violation. This study aimed to quantify the articular surface loss after insertion of the RHCS and determine the functional range of motion (ROM) of the metacarpophalangeal (MCP) joint at the point of contact between the proximal phalangeal (P1) base and the articular defect. METHODS Ten fresh-frozen cadaveric hand specimens were analyzed for prefixation MCP joint ROM. After screw insertion, the ROM at which the dorsal portion of the P1 base begins to engage the screw tract defect, as well as the ROM at which the midsagittal portion of the P1 bisector engages the screw tract defect, was recorded. The distal axial articular surface of the metacarpal and the defects from screw insertion were measured using a digital image software program. RESULTS Nine men and one woman (mean age, 69 years) were examined. The prefixation mean extension-flexion arc for all MCP joints ranged from 1° to 85°. After screw insertion, the mean MCP ROM at which the dorsal P1 articular surface first engaged the screw tract was 31°. Only 7 digits had screw tract engagement with the midsagittal bisector of the P1 base at a mean flexion angle of -18° (18° hyperextension). Mean articular surface violation increased from the index finger moving ulnarly, with an average of 3.9% involvement. CONCLUSIONS Articular surface loss of the metacarpal head following RHCS insertion is negligible in a cadaveric model, with minimal engagement between the corresponding defect and the P1 base during functional ROM. CLINICAL RELEVANCE Retrograde headless compression screw fixation of metacarpals inevitably damages the cartilage. However, the actual defect is small in proportion to the articular surface area and not engaged during functional activity. These biomechanical features may mitigate the surgeon's concern about joint destruction, while ensuring the benefits of early rehabilitation and minimal invasiveness of this technique.
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Affiliation(s)
- Andrew J Straszewski
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.
| | - Jason L Dickherber
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Megan Anne Conti Mica
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
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Powers R, Lynch T, Bates T, Rask D, Achay JA, Plucknette B, Wilson D. Extensor Tendon Integrity After Percutaneous Placement of Intramedullary Metacarpal Screws: A Cadaveric Study. Hand (N Y) 2023; 18:1336-1341. [PMID: 35794844 PMCID: PMC10617485 DOI: 10.1177/15589447221105545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intramedullary implants are an increasingly common method for fixation of metacarpal fractures. Numerous techniques for instrumentation have been described with varied consideration for the risk of extensor tendon injury. The current cadaveric study evaluates the prevalence and degree of extensor tendon injury and compares percutaneous approaches with different drilling techniques. METHODS Ninety-six metacarpals (thumbs excluded) from 24 fresh-frozen cadaveric upper extremities were used to compare 2 percutaneous approaches and 2 drilling techniques. This resulted in 4 subgroups available for comparison: oscillate to bone (OB), forward to bone (FB), oscillating through the skin (OS), and forward through the skin (FS). After instrumentation, the extensor tendons were dissected and disruption was characterized. The main outcome measures were tendon "hit rate" and relative extensor tendon defect width. RESULTS Tendon hit rate was significantly higher in the long finger (LF), that is, 79.2%, compared with other metacarpals: index finger, 20.8%; ring finger, 12.5%; and small finger 25%. The mean relative tendon disruption was significantly less in the OB group (16.05%) compared with the other groups: FB (31.84%), FS (31.50%), and OS (29.85%). CONCLUSION Retrograde intramedullary screw fixation of metacarpal fractures can be performed using percutaneous approaches without a significant disruption of the extensor mechanism. Instrumentation through a longitudinal stab incision down to the metacarpal head and the use of drill oscillation minimize injury to the extensor tendons. The LF extensor tendon is most at risk with retrograde intramedullary implant placement.
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Affiliation(s)
- Robert Powers
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Thomas Lynch
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Taylor Bates
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Dawn Rask
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | | | | | - David Wilson
- San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Anene CC, Thomas TL, Matzon JL, Jones CM. Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review. J Hand Surg Am 2023:S0363-5023(23)00035-7. [PMID: 36878755 DOI: 10.1016/j.jhsa.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures. METHODS A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data. RESULTS Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery. CONCLUSIONS Complications following IMS fixation of metacarpal fractures are relatively uncommon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Chibuzo C Anene
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Terence L Thomas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jonas L Matzon
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Christopher M Jones
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA.
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8
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Ideal Length and Diameter for Intramedullary Screw Fixation of Metacarpal Fractures: A Biomechanical Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:189-195. [PMID: 36974302 PMCID: PMC10039306 DOI: 10.1016/j.jhsg.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose This biomechanical study evaluated the effect of intramedullary screw diameter and length relative to 3-point bending force and torsional force when used to stabilize metacarpal shaft fractures. Methods Transverse osteotomies were made in the proximal metacarpal shaft in 36 middle finger metacarpal fourth-generation composite Sawbones. To compare screw diameters, antegrade intramedullary screws of 30-mm length were placed in 6 metacarpals, which included 4.7-mm Acutrak 2, Standard Acutrak 2 (4.0 mm), and Mini-Acutrak 2 (3.5 mm) screws. To compare screw lengths, metacarpals were fixated with Standard Acutrak 2 screws of 26, 30, or 34 mm in length, with screw tips bypassing the osteotomy by 6, 10, or 14 mm, respectively. A 6 degrees of freedom robot was used for torsional and 3-point bending testing. Results Increasing screw diameter demonstrated significant differences in both 3-point bending and torsional strengths. Maximum torsional loads were 69 Ncm (4.7-mm Acutrak 2), 45 Ncm (Standard Acutrak 2), and 27 Ncm (Mini-Acutrak 2) (P < .05). Loads to failure in the 3-point bending tests were 916 N (4.7-mm Acutrak 2), 713 N (Standard Acutrak 2), and 284 N (Mini-Acutrak 2) (P < .05). Differing screw lengths demonstrated significant differences with maximum torsional loads when comparing the 26-mm screws (22 Ncm) with 30- and 34-mm screws (45 and 55 Ncm, respectively) (P < .05). The 3-point dorsal bending strengths were significantly different between the 26-mm screws (320 N) and 30- and 34-mm screws (713 N and 702 N, respectively) (P < .05). Conclusions The results demonstrated significantly higher torsional strength and resistance to 3-point bending with larger intramedullary screw diameters. Further, when selecting the intramedullary screw length, the screw tip should pass at least 10 mm beyond the fracture. Clinical Relevance This study provided biomechanical evidence to guide surgeons in selecting intramedullary screw diameter and length for treating metacarpal fractures.
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Abstract
Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. A comprehensive literature search was performed using electronic databases for both clinical and biomechanical studies in relation to RIS fixation published from 2000 to 2020. A total of 19 studies (13 clinical and 6 biomechanical) met the inclusion criteria. The clinical studies examined 603 metacarpal fractures and demonstrated adequate functional outcomes in terms of grip strength, total active motion, and time to return to work. The biomechanical studies examined 80 metacarpal fractures, finding that load to failure in RISs was often equal to or higher than Kirschner wires but less than plate and screws. The complication rate in reviewed studies was 2.8%, with the most prevalent complications being stiffness and extension lag. RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality.
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Affiliation(s)
| | - Taylor Rider
- Philadelphia College of Osteopathic
Medicine, PA, USA
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10
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Baum GR, Dang M, Yeater TB, Brown E, Cox CT, Bourland B, MacKay BJ. Threaded intramedullary headless nail fixation for fractures requiring carpometacarpal stabilization. JPRAS Open 2022; 35:29-37. [PMID: 36620182 PMCID: PMC9817090 DOI: 10.1016/j.jpra.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Carpometacarpal (CMC) fracture-dislocations are uncommon hand injuries, with few studies available regarding their treatment. The current operative treatment options include fixation with K-wires, mini-screws, or plates, though there is no standardized approach because of varying injury patterns and complications associated with each device. The INnate™ threaded intramedullary nail is a relatively novel treatment option that has shown promise in metacarpal fracture fixation by facilitating faster mobilization and recovery with enhanced rotational stability and no compression to prevent fracture displacement and shortening. This study assesses the efficacy of the INnate™ nail for fixation of CMC fracture-dislocations of the second through fifth joints. Nine patients with fourteen CMC fracture-dislocations treated with the INnate™ nail at the University Medical Center between 2019 and 2021 were enrolled in the study. We evaluated postoperative outcomes in terms of pain, total active range of motion (TAM), and return to normal activities. Of the nine patients, seven returned for follow-up. The average time to radiographic union was 11.5 weeks. At final follow-up, no patient reported pain (n = 6). Four patients had 100% TAM, 1 had 95% TAM, and 1 had 25% TAM. The average percentage of normal activity resumed was 84.0% (n = 5). No significant complications were reported. One patient had a dorsal spanning plate; hence, we were unable to record outcomes measures regarding the CMC injury. An additional patient had diminished ROM of the injured hand, but his last follow-up was only 1 month postop. Our pilot data overall suggest that the INnate™ threaded intramedullary nail has the potential to improve treatment algorithms for CMC fracture-dislocations.
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Affiliation(s)
- Gracie R. Baum
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Science Center, 808 Joliet Ave Suite 310, Lubbock, TX 79430, United States
| | - Michael Dang
- Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States
| | - Thomas B. Yeater
- Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States
| | - Elizabeth Brown
- Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, United States
| | - Cameron T. Cox
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Science Center, 808 Joliet Ave Suite 310, Lubbock, TX 79430, United States
| | - Bryan Bourland
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Science Center, 808 Joliet Ave Suite 310, Lubbock, TX 79430, United States
| | - Brendan J. MacKay
- Department of Orthopaedic Hand Surgery, Texas Tech University Health Science Center, 808 Joliet Ave Suite 310, Lubbock, TX 79430, United States,Corresponding author.
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11
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Braig ZV, Kakar S. Kickstand Technique for Intraoperative Reduction of Fifth Metacarpal Neck Fractures. J Hand Surg Am 2022; 47:799.e1-799.e7. [PMID: 35623923 DOI: 10.1016/j.jhsa.2022.02.024] [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: 01/13/2022] [Accepted: 02/27/2022] [Indexed: 02/02/2023]
Abstract
This article reports a novel intraoperative technique for the reduction of angulated metacarpal neck fractures undergoing retrograde headless intramedullary screw fixation. This technique is a useful reduction maneuver, especially for hand surgeons operating without a first assistant, because it eliminates the need to hold manual reduction during implant placement.
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Affiliation(s)
- Zachary V Braig
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Sanjeev Kakar
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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12
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Saade F, Bouteille C, Obert L, Lepage D, Loisel F, Menu G. [Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]. ANN CHIR PLAST ESTH 2022:S0294-1260(22)00104-2. [PMID: 35902287 DOI: 10.1016/j.anplas.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique. MATERIAL AND METHOD We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage. RESULTS At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily. CONCLUSION This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.
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Affiliation(s)
- F Saade
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France.
| | - C Bouteille
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - L Obert
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - D Lepage
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - F Loisel
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - G Menu
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
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Okoli M, Chatterji R, Ilyas A, Kirkpatrick W, Abboudi J, Jones CM. Intramedullary Headless Screw Fixation of Metacarpal Fractures: A Radiographic Analysis for Optimal Screw Choice. Hand (N Y) 2022; 17:245-253. [PMID: 32432499 PMCID: PMC8984717 DOI: 10.1177/1558944720919897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: The purpose of this study was to investigate variations in radiographic metacarpal anatomy as it relates to intramedullary (IM) fixation of metacarpal fractures and to compare this anatomy with available headless screw dimensions. Methods: We radiographically analyzed posteroanterior and lateral (LAT) radiographs of 120 metacarpals across 30 patients without structural abnormalities. Primary outcomes included IM isthmus diameter, isthmus location, metacarpal cascade, and head entry point collinear with IM canal. Measurements were compared with a list of commercially available headless screws used for IM fixation. Results: The average largest isthmus diameter was in the small metacarpal (3.4 mm), followed by the index (2.8 mm), long (2.7 mm), and ring (2.7 mm) metacarpals. The average cascade angle between long and index, long and ring, and long and small metacarpals was 0°, 24°, and 27°, respectively. The appropriate head entry point ranged between 25% and 35% from the dorsal surface of the metacarpal head on a LAT view. The retrograde isthmus location of the index and long finger was 39.2 and 38.1 mm, respectively. Twenty-five screws from 7 manufacturers were analyzed with sizes ranging from 1.7 to 4.5 mm. Only 8 of 17 screws between 2.3 and 3.5 mm had a length range above 35 mm. Conclusions: Metacarpal head entry point and cascade angle can help identify the appropriate reduction with the guide pin starting point in the dorsal 25% to 35% of the metacarpal head. Surgeons should be mindful to choose the appropriate fixation system in light of the variations between metacarpal isthmus size, isthmus location, and available screw lengths.
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Affiliation(s)
- Michael Okoli
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | - Rishi Chatterji
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA
| | - Asif Ilyas
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | | | - Jack Abboudi
- Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | - Christopher M. Jones
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA,Christopher M. Jones, 825 Old Lancaster
Road, Suite140, Bryn Mawr, PA 19010, USA.
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14
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Wolf GJ, Goodloe JB, Bailey EP, Barcel JA, Daley DN. Surgical outcomes of intramedullary screw fixation for metacarpal fractures. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Galbraith JG, Huntington LS, Borbas P, Ackland DC, Tham SK, Ek ET. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures. J Hand Surg Eur Vol 2022; 47:172-178. [PMID: 34018870 DOI: 10.1177/17531934211017705] [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: 02/03/2023]
Abstract
We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation. Transverse mid-diaphyseal fractures were created in 64 metacarpal sawbones and were assigned into four groups. Peak load to failure and stiffness were measured in cantilever bending and torsion. We found that dorsal plating had the highest peak load to failure. However, initial bending stiffness of the 3.0 mm intramedullary headless compression screw was higher than that of the dorsal plates. In torsion testing, dorsal plating had the highest peak torque, but there was no significant difference in torsional stiffness between the plate and intramedullary headless compression screw constructs. We concluded that intramedullary headless compression screw fixation is biomechanically superior to K-wires in cantilever bending and torsion; however, it is less stable than dorsal plating. In our study, the initial stability provided by K-wire fixation was sufficient to cope with expected loads in the early rehabilitation period, whereas dorsal plates and IHCS constructs provided stability far in excess of what is required.
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Affiliation(s)
- John G Galbraith
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia
| | - Lachlan S Huntington
- Department of Biomechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Borbas
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Biomechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen K Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia This study was performed at the Department of Biomechanical Engineering, University of Melbourne, Australia, and the Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute
| | - Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Clayton, VIC, Australia This study was performed at the Department of Biomechanical Engineering, University of Melbourne, Australia, and the Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute
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16
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Kibar B, Cavit A, Örs A. A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures. J Hand Surg Eur Vol 2022; 47:179-185. [PMID: 34107786 DOI: 10.1177/17531934211021521] [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] [Indexed: 02/03/2023]
Abstract
We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18-61) in the IHCS group and 32 years (range 17-68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures.Level of evidence: I.
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Affiliation(s)
- Birkan Kibar
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Cavit
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Abdullah Örs
- Department of Anatomy, Kocaeli Üniversity, İzmit, Turkey
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17
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Mousafeiris VK, Papaioannou I, Kalyva N, Pantazidou G, Repantis T. Horizontal (Transverse) Intraarticular Metacarpal Head Fracture in a Young Adult. Cureus 2021; 13:e16720. [PMID: 34513355 PMCID: PMC8405176 DOI: 10.7759/cureus.16720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
Metacarpal head fractures are rare injuries that usually occur during trauma. These fractures are classified into 10 groups, with horizontal (transverse) being the rarest type of fractures. To our knowledge, very few cases have been reported in the literature to date. Here, we present the case of a 21-year-old male who sustained multiple ipsilateral hand injuries accompanied by a horizontal (transverse) fracture of the fourth metacarpal. He underwent open reduction and fixation with Kirschner wires followed by intensive rehabilitation. He finally regained complete active range of motion and grip strength three months after the operation. However, at nine months postoperatively, he developed avascular necrosis, which was asymptomatic and did not need any intervention. Therefore, it is important to maintain a high index of suspicion for possible complications and follow patients regularly, probably even for as long as 12 months after the initial injury.
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Affiliation(s)
| | | | | | - Georgia Pantazidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras "Agios Andreas", Patras, GRC
| | - Thomas Repantis
- Orthopedics, General Hospital of Patras "Agios Andreas", Patras, GRC
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18
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Camacho E, Craviotto M, D'Oliveira L. How to Manage Complications Related to the Use of Intramedullary Screws in Metacarpal Fractures: Case Series. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1730001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractThe use of intramedullary screws has been increasing among hand surgeons in cases of metacarpal fractures due to their low morbidity, and because they minimize incisions and dissection, and require less tissue manipulation and deperiostization. However, there are few published articles on the complications that arise from its use. Therefore, the purpose of the current study is to present a series of cases of complications following the use of intramedullary screws in metacarpal fractures that required surgical intervention, and to describe the surgical technique used to solve them .
Methods We performed a retrospective multicenter study in which we reviewed the clinical history, surgical descriptions and radiographs of the patients submitted to fixation of intramedullary compression screws for metacarpal fractures. We defined as complications infection, lesion to the extensor apparatus, bending of the implant, loss of reduction, hardware failure, malrotation, and non-union.
Results Out of a total of 45 patients, we reported 3 cases of complication: 1 patient with loss of reduction, and 2 patients with bending of the implant. In the three cases, the screw was removed without complications, and the focus of the fracture was stabilized.
Conclusion Intramedullary fixation with compression screws is increasingly being used for metacarpal fractures, with reports of low rates of complications. In the series of cases herein reported, the complications were solved without difficulty, and the patients showed a good recovery in hand function in the follow-up. Knowledge of the possible complications and their management enables us to provide more safety to the patient at the time of choosing this technique.
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Affiliation(s)
- Eliana Camacho
- Esthetic and Reconstructive Plastic Surgery Service, Hospital de Clínicas, Montevideo, Uruguay
- Plastic Surgery Department, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Matías Craviotto
- Esthetic and Reconstructive Plastic Surgery Service, Hospital de Clínicas, Montevideo, Uruguay
- Plastic Surgery Department, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Lucía D'Oliveira
- Esthetic and Reconstructive Plastic Surgery Service, Hospital de Clínicas, Montevideo, Uruguay
- Plastic Surgery Department, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
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19
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García-Medrano B, Honecker S, Facca S, Simón FP, Delgado PJ, Liverneaux P. Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:427-436. [PMID: 33999263 DOI: 10.1007/s00590-021-02977-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Belén García-Medrano
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain.
| | - Sophie Honecker
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.,UMR7357, ICube CNRS, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France
| | - Fernando Polo Simón
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain
| | - Pedro J Delgado
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.,UMR7357, ICube CNRS, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France
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20
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Duerinckx J, Caekebeke P. Minimally Invasive Corrective Osteotomy for Metacarpal Malrotation. Tech Hand Up Extrem Surg 2021; 26:47-50. [PMID: 35179136 DOI: 10.1097/bth.0000000000000356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Metacarpal fractures can be complicated by malrotation. This can cause functional problems with overriding or underriding of the fingers with flexion. Surgical treatment consists of corrective osteotomy and derotation. This is typically performed open and different techniques for osteotomy and fixation have been described. Postoperative complications include finger stiffness and hardware irritation. We propose a technique for minimally invasive corrective osteotomy of malunited metacarpal fractures with rotational malalignement. Advantages are quick rehabilitation and no prominent hardware.
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Affiliation(s)
- Joris Duerinckx
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium
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21
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Hoang D, Vu CL, Huang JI. Evaluation of Antegrade Intramedullary Compression Screw Fixation of Metacarpal Shaft Fractures in a Cadaver Model. J Hand Surg Am 2021; 46:428.e1-428.e7. [PMID: 33358079 DOI: 10.1016/j.jhsa.2020.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/04/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgical options for displaced metacarpal shaft fractures include the use of Kirschner wires, plates and screws, and most recently, intramedullary headless compression screws (IMHCS), which have been reported using only retrograde insertion through the metacarpal head. We evaluated IMHCS fixation of metacarpal shaft fractures through an antegrade approach in a cadaver model. METHODS We performed antegrade placement of IMHCS in 10 cadaver hands including all 5 digits (total of 50). Displaced transverse proximal metacarpal shaft fractures were created and reduced with a retrograde guidewire from the metacarpal head across the shaft fracture and exiting the metacarpal base. This was retrieved through a 6-mm dorsal wrist incision and overdrilled before the placement of a 4.1-mm-diameter IMHCS in the ring finger and a 4.7-mm screw in all other metacarpals. After IMHCS placement, carpometacarpal (CMC) joint violation was measured along with the optimal starting point for the guidewire on the metacarpal head relative to the dorsal cortex. RESULTS In all 50 metacarpals, we achieved successful fracture reduction and fixation without violating the extensor mechanism at the wrist. Our retrograde guidewire entry point through the metacarpal head ranged from 4.2 to 4.7 mm volar to the dorsal cortex. The actual area of CMC joint violated by IMHCS placement was largest in the index CMC joint (4.9%), followed by the middle (3.7%), little (2.9%), ring (0.5%), and thumb joints (0.2%). CONCLUSIONS Placement of IMHCS through an antegrade approach from the CMC joint can be performed effectively for all transverse metacarpal fractures, including the thumb, using a limited incision. There is minimal violation of the articular surfaces of the trapezium, capitate, and hamate for the thumb, middle, ring, and little metacarpals. CLINICAL RELEVANCE Antegrade IMHCS fixation successfully avoids the potential morbidity of creating a metacarpal head articular surface or extensor mechanism defect at the metacarpophalangeal joint seen with the retrograde approaches.
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Affiliation(s)
- Don Hoang
- Department of Hand, Upper Extremity, and Microsurgery, Division of Plastic and Reconstructive Surgery, Santa Clara Valley Medical Center, San, Jose, CA.
| | - Catphuong L Vu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
| | - Jerry I Huang
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
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22
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Hug U, Fiumedinisi F, Pallaver A, van de Wall BJM, Beeres FJP, Giesen T, Liechti R. Intramedullary screw fixation of metacarpal and phalangeal fractures - A systematic review of 837 patients. HAND SURGERY & REHABILITATION 2021; 40:622-630. [PMID: 33933635 DOI: 10.1016/j.hansur.2021.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique is currently the subject of controversy among hand surgeons. The aim of this systematic review was to gain insight on radiological, functional and patient-rated outcomes reported in literature. A comprehensive literature search of PubMed, Embase, CENTRAL and CINAHL databases was conducted on March 1st, 2021. All studies reporting on fracture union, complications, and functional and patient-rated outcome in IMS fixation of metacarpal and/or phalangeal fractures were selected. Two prospective and 16 retrospective cohort studies were included, encompassing a total of 837 patients with 958 fractures (693 metacarpal, 222 proximal phalangeal and 43 middle phalangeal). Mean surgery duration was 26.4 min (range 5-60 min). Union was ultimately achieved in all fractures in a mean of 5.7 weeks (range 2-12 weeks). The procedure-related complication rate was 3.2%. The most frequently reported complication was limitation of joint motion, occurring in 2.0% of cases. Incidence of other complications, including loss of reduction, infection and screw protrusion did not exceed 1%. Overall mean total active motion averaged 243° and grip strength reached 97.5% of the contralateral side. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 3.7 points. Duration of sick leave was 7.3 weeks. According to the findings of this systematic review, IMS fixation is a time-saving and safe minimally invasive solution for both metacarpal and phalangeal fractures, with a low rate of complications and promising functional and patient-rated results.
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Affiliation(s)
- U Hug
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - F Fiumedinisi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - A Pallaver
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - B J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - F J P Beeres
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - T Giesen
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - R Liechti
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland.
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23
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Folberg CR, Alves JADO, Cadore OP, Sirena FM. Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases. Rev Bras Ortop 2021; 56:198-204. [PMID: 33935315 PMCID: PMC8075639 DOI: 10.1055/s-0040-1714229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022] Open
Abstract
Objective
The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type).
Methods
Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018.
Results
The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5
th
, 3
rd
, and 2
nd
(n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30° for the 2
nd
and 3
rd
metacarpals and > 40° for the 5
th
metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240° and returned to their former occupations. All fractures consolidated and there were no reinterventions.
Discussion
The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost.
Conclusion
This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.
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Affiliation(s)
- Celso Ricardo Folberg
- Grupo de Cirurgia da Mão, Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Jairo André de Oliveira Alves
- Grupo de Cirurgia da Mão, Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Otávio Pereira Cadore
- Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Fernando Maurente Sirena
- Grupo de Cirurgia da Mão, Serviço de Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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24
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Hoang D, Vu CL, Jackson M, Huang JI. An Anatomical Study of Metacarpal Morphology Utilizing CT Scans: Evaluating Parameters for Antegrade Intramedullary Compression Screw Fixation of Metacarpal Fractures. J Hand Surg Am 2021; 46:149.e1-149.e8. [PMID: 33092908 DOI: 10.1016/j.jhsa.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/28/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study evaluated metacarpal morphology for antegrade placement of intramedullary headless compression screws (IMHCS) for metacarpal fracture fixation. METHODS We analyzed 100 hand computed tomography scans to quantify cortical thickness, intramedullary diameter, and metacarpal lengths. In addition, dorsal or ulnar overhang of the metacarpals over their respective carpal bones was measured. We also predicted optimal entry points for guidewire placement at the metacarpal head. RESULTS The ring finger metacarpal had the narrowest medullary canal width (coronal, 2.8 mm; sagittal, 3.5 mm). Not counting the thumb, the little finger metacarpal had the widest midshaft medullary width of 4.1 mm in the coronal plane and the middle metacarpal was widest in the sagittal plane with canal width of 3.9 mm. On average, there was maximal dorsal overhang at the base of the middle metacarpal (4.2 mm) and maximal ulnar overhang at the base of the small metacarpal (3.9 mm). The optimal entry point for guidewire placement over each metacarpal head was approximately 3.5 to 3.8 mm volar to the dorsal cortex. CONCLUSIONS Minimum IMHCS diameters of 3.5 mm for the ring and 4.0 mm for the index, middle and little fingers are necessary to achieve interference fit within the medullary canal. Minimum screw lengths of 38 mm would be needed to ensure 6 mm fixation past the midshaft of the metacarpals. Antegrade IMHCS for fixation of proximal metacarpal fractures may be most feasible with thumb, middle, and little finger metacarpals because there was larger dorsal or ulnar overhang to allow screw placement without violating the carpometacarpal joints. CLINICAL RELEVANCE Our analysis provides a reference guide for intramedullary screw sizes for each metacarpal of the hand to achieve interference fit with fracture fixation. Furthermore, the dorsal and ulnar overhangs of the metacarpal bases suggest the practicality of antegrade IMHCS fixation.
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Affiliation(s)
- Don Hoang
- Hand, Upper Extremity, and Microsurgery, Division of Plastic and Reconstructive Surgery, Santa Clara Valley Medical Center, San Jose, CA.
| | - Catphuong L Vu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
| | - Madeleine Jackson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
| | - Jerry I Huang
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA
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25
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Guidi M, Frueh FS, Besmens I, Calcagni M. Intramedullary compression screw fixation of metacarpal and phalangeal fractures. EFORT Open Rev 2020; 5:624-629. [PMID: 33204505 PMCID: PMC7608511 DOI: 10.1302/2058-5241.5.190068] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The intramedullary headless compression screw (IMCS) technique represents a reliable alternative to percutaneous Kirschner-wire and plate fixation with minimal complications. Transverse fractures of the metacarpal shaft represent a good indication for this technique. Non-comminuted subcapital and short oblique fractures can also be treated with IMCS. This technique should not be used in the presence of an open epiphysis, infection and, most of all, in subchondral fractures, because of the lack of purchase for the head of the screw. A double screw construct is recommended for comminuted subcapital fractures of the metacarpal to avoid metacarpal shortening. IMCS can even be applied for peri-articular fractures of the proximal third of the phalanx and in some multi-fragmentary proximal and middle phalangeal fractures. Usually the intramedullary screws are not removed. The main indications for screw removal are joint protrusion, infection and screw breakage after new fracture.
Cite this article: EFORT Open Rev 2020;5:624-629. DOI: 10.1302/2058-5241.5.190068
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Affiliation(s)
- Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Florian S Frueh
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Inga Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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Rausch V, Harbrecht A, Kahmann SL, Fenten T, Jovanovic N, Hackl M, Müller LP, Staat M, Wegmann K. Osteosynthesis of Phalangeal Fractures: Biomechanical Comparison of Kirschner Wires, Plates, and Compression Screws. J Hand Surg Am 2020; 45:987.e1-987.e8. [PMID: 32499069 DOI: 10.1016/j.jhsa.2020.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/14/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model. METHODS A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine. RESULTS Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup. CONCLUSIONS Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability. CLINICAL RELEVANCE Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.
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Affiliation(s)
- Valentin Rausch
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Andreas Harbrecht
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany; Department of Anatomy I, Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Stephanie L Kahmann
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany; Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Thomas Fenten
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Nebojsa Jovanovic
- Department of Trauma and Orthopedics, Hand and Microsurgery Unit, Rashid Hospital, Dubai Health Authority, Oud Metha, Dubai
| | - Michael Hackl
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Lars P Müller
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Kilian Wegmann
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
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Labèr R, Jann D, Behm P, Ferguson SJ, Frueh FS, Calcagni M. Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study. J Hand Surg Eur Vol 2020; 45:595-600. [PMID: 31948331 DOI: 10.1177/1753193419898066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intramedullary cannulated compression screws have been introduced for the fixation of unstable metacarpal fractures. In the present study, this technique was compared with dorsal compression plating to evaluate its biomechanical performance in stabilizing metacarpal shaft fractures. In a first set of experiments, the biomechanical characteristics of the screws were analysed in an artificial bone model. In subsequent experiments, midshaft osteotomies were performed in human cadaver metacarpals, followed by plating or intramedullary screw osteosynthesis. The metacarpals were tested to failure in cantilever bending, following a stepwise increasing cyclic loading protocol. We found a significantly lower load at failure and a significantly lower number of cycles to failure in the intramedullary screw group, but both methods offered sufficient stability under these loads. With reference to published loads on the metacarpals during use of the hand, we conclude that intramedullary osteosynthesis yields sufficient strength and stiffness for early active motion. A difference in its fixation stability is noted compared with plate fixation, which may not be clinically relevant.
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Affiliation(s)
- Raffael Labèr
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - David Jann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Florian S Frueh
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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Barrera-Ochoa S, Alabau-Rodriguez S, Campillo-Recio D, Esteban-Feliu I, Mir-Bullo X, Soldado F. Retrograde intramedullary headless compression screws for treatment of extra-articular thumb metacarpal base fractures. J Hand Surg Eur Vol 2020; 45:588-594. [PMID: 32397785 DOI: 10.1177/1753193420924215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of the study was to evaluate clinical and radiological outcomes of extra-articular fractures involving the base of the thumb metacarpal treated with fixation using a retrograde intramedullary cannulated headless screw. A review of prospectively collected data was conducted on a consecutive series of 13 patients, treated with headless screw fixation for acute displaced fractures. All workers resumed full duties, while non-workers returned to unlimited leisure activities within a mean of 42 days. At 3 months follow-up, all range of motion measurements in the treated and untreated thumb were similar. Mean visual analogue pain score was 0.8 at rest and 1.4 during exercise and mean Quick Disabilities of the Arm, Shoulder, and Hand score was 5. All patients achieved radiographic union by 8 weeks. We conclude that the intramedullary headless screw fixation is safe and reliable for base of thumb metacarpal fractures, allowing for early postoperative motion and good functional recovery. Level of evidence: IV.
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Affiliation(s)
- Sergi Barrera-Ochoa
- icatMA Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - Sergi Alabau-Rodriguez
- icatMA Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - David Campillo-Recio
- icatMA Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
| | - Ignacio Esteban-Feliu
- icatMA Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Mir-Bullo
- icatMA Hand and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, Barcelona, Spain
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Soldado
- Pediatric Hand Surgery and Microsurgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
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Urbanschitz L, Dreu M, Wagner J, Kaufmann R, Jeserschek JM, Borbas P. Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures. J Hand Surg Eur Vol 2020; 45:601-607. [PMID: 32370585 DOI: 10.1177/1753193420919060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteosynthesis of metacarpal and phalangeal fractures with headless compression screws leads to a defect in the articular surface and possibly damage to the extensor tendons. This study aimed to quantify the articular surface defect and extensor tendon injuries after implant placement in cadaveric hands. Defect size was assessed with computed tomography. Extensor tendon injuries were assessed by direct visualization and measurement after dissection. In the middle phalanx, the defect size in relation to the joint surface was significantly smaller after anterograde screw placement when compared with retrograde placement. Also, a mini-open approach was found to cause significantly less tendon injury than a percutaneous approach, but there was no difference in tendon damage between retrograde and antegrade screw insertion into the middle phalanx.
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Affiliation(s)
- Lukas Urbanschitz
- Department of Orthopaedic Surgery, Cantonal Hospital Baden, Baden, Switzerland
| | - Manuel Dreu
- Institute of Anatomy, Medical University Graz, Graz, Austria
| | - Julia Wagner
- Institute of Anatomy, Medical University Graz, Graz, Austria
| | - Reinhard Kaufmann
- Department of Interventional Radiology, University Hospital Basel, Basel, Switzerland
| | | | - Paul Borbas
- Department of Orthopaedic Surgery, Cantonal Hospital Baden, Baden, Switzerland
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30
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Hoang D, Huang J. Antegrade Intramedullary Screw Fixation: A Novel Approach to Metacarpal Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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31
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Siddiqui AA, Kumar J, Jamil M, Adeel M, Kaimkhani GM. Fixation of Metacarpal Fractures Using Intramedullary Headless Compression Screws: A Tertiary Care Institution Experience. Cureus 2019; 11:e4466. [PMID: 31249744 PMCID: PMC6579341 DOI: 10.7759/cureus.4466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Metacarpal fractures account for the majority of hand fractures. Inadequate management can cause functional deficit which can lead to loss of fine hand movements. Adequate management has proven to give good outcomes. The use of intramedullary screws has given better results than the use of Kirschner wires (K-wires). Method This study was conducted at Dr. Ruth Phau Civil Hospital, Karachi (CHK) between August 1, 2018 and January 31, 2019. A total of 32 patients presented with metacarpal fractures. They were surgically managed with intramedullary headless screw fixation. Post-operatively, grip strength, range of motion, and presence of any disabilities were recorded. Patients were followed up to three months. Results Out of 32 patients, six were females. Mean age was found to be 29.1 ± 10.5 years. Post-operatively the mean grip strength was found to be 37.8 ± 7.3 kilograms. The mean total active range of motion was found to be 242.8 ±14.5 degrees. The mean days to return back to work were 25 ± 5.4 days. The mean patient satisfaction score was 8.1 ± 0.79. Three patients developed post-operative stiffness of the joint. Conclusion Patients with intramedullary screw fixation have good post-operative results with early return to work.
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Affiliation(s)
- Adeel A Siddiqui
- Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Jagdesh Kumar
- Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Mariyam Adeel
- Orthopaedics, Dow University of Health Sciences, Karachi, PAK
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32
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Intramedullary Screw Fixation of Metacarpal Fractures Results in Excellent Functional Outcomes. Plast Reconstr Surg 2019; 143:1111-1118. [DOI: 10.1097/prs.0000000000005478] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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