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Abhishek MP, Sikha JR, Pal AK, Gelada K, Sethi S, Sameer Kumar Naik BSSR, Tiwari RVC. Evaluation of Efficacy of Different Plating Systems in ZMC Fractures: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S247-S249. [PMID: 38595517 PMCID: PMC11000965 DOI: 10.4103/jpbs.jpbs_481_23] [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: 08/03/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 04/11/2024] Open
Abstract
Objective This study's objective was to assess and contrast the performance of several plating techniques in the treatment of zygomaticomaxillary complex (ZMC) fractures. Group A (Microplate System), Group B (Titanium Mesh System), and Group C (Absorbable Plate System) plating systems were the ones that were studied. Materials and Methods With 10 patients in each group, a retrospective analysis of 30 patients with ZMC fractures was done. The following information was gathered: fracture reduction, stable fixation, complications, and patient satisfaction. Analysis was done on patient-reported outcomes, surgical outcomes, and demographic factors. Results Group B (Titanium Mesh System) came in second with rates of 70% and 80%, respectively, while Group A (Microplate System) showed the highest rates of fracture reduction (90%) and stable fixation (100%). For fracture reduction and stable fixation, Group C (Absorbable Plate System) demonstrated rates of 80% and 90%, respectively. For Groups A, B, and C, the complication rates were 20%, 30%, and 10%, respectively. For Groups A, B, and C, the patient satisfaction levels were 90%, 80%, and 70%, respectively. Conclusion According to the results, the Microplate System (Group A) is better than the Titanium Mesh System (Group B) and the Absorbable Plate System (Group C) in terms of fracture reduction and stable fixation when treating ZMC fractures. All plating systems had acceptable complication rates, and overall patient satisfaction ratings were high. Fracture features and patient-specific considerations should be taken into account while making individualized treatment options.
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Affiliation(s)
- MP Abhishek
- Department of ENT, Chamarajanagara Institute of Medical Sciences (CIMS), Chamarajanagara, Karnataka, India
| | - John R. Sikha
- Gitam Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Arvind K. Pal
- Department of OMFS, IDST Dental College Kadrabad, Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Kalyani Gelada
- Consultant Oral and Maxillofacial Surgeon, Pune, Maharashtra, India
| | - Sanjana Sethi
- Consultant Oral and Maxillofacial Surgeon, Pune, Maharashtra, India
| | | | - Rahul V. C. Tiwari
- Consultant Oral and Maxillofacial Surgeon, OMNI Hospitals, Visakhapatnam, Andhra Pradesh, India
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Huang CH, Lo IN, Wang JP. The Addition of a Temporary Intramedullary K-wire to Facilitate Plating for Metacarpal Fractures. Tech Hand Up Extrem Surg 2023; 27:45-48. [PMID: 35993564 DOI: 10.1097/bth.0000000000000408] [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: 11/26/2022]
Abstract
Open reduction internal fixation with plate fixation is commonly used in treating metacarpal fractures to facilitate early rehabilitation. However, it is sometimes challenging to maintain a satisfactory 3-dimensional alignment during the plating process. We present a method using a temporary centrally placed intramedullary k-wire to maintain a fundamental stability for reduction of metacarpal fractures. This method facilitates the plating process and simplifies the open reduction internal fixation of the metacarpal fractures.
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Affiliation(s)
- Chi-Han Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Ning Lo
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sehjal R, Rusli W, Kedgley AE, Sagmeister ML, Williamson M, Smith A. Biomechanical Comparison of 5 Different Fixation Constructs in a Trapeziometacarpal Joint Arthrodesis Model. J Hand Surg Am 2023:S0363-5023(22)00771-7. [PMID: 36764846 DOI: 10.1016/j.jhsa.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE Trapeziometacarpal joint (TMC) arthrodesis has a high rate of nonunion. This biomechanical analysis sought to determine the stiffness of 5 fixation methods in a TMC joint arthrodesis model. METHODS Five fixation constructs were tested in a validated porcine model: crossed 1.1-mm K-wires, crossed 1.6-mm K-wires, crossed headless compression screws (HCSs), compression plating (CP), and locked compression plating (LCP). The cantilever bending stiffness was measured in abduction, adduction, flexion, and extension. Samples were loaded to failure in extension, and the mode of failure was examined. RESULTS The crossed HCSs performed consistently well in all tests. Loading to failure resulted in screw pullout. In abduction and adduction, HCS and 1.6-mm K-wires were significantly stiffer than the other constructs. The mean load to failure in extension was similar in the HCS, CP, and LCP groups (304 N/mm, 311 N/mm, and 293 N/mm, respectively). There were no differences between CP and LCP in any biomechanical tests, and the mode of failure was through plate bending. The crossed 1.1-mm K-wires performed poorly in all tests. CONCLUSIONS Crossed HCS displayed the greatest overall stability. Standard plating in compression mode and LCP had a similar biomechanical performance. CLINICAL RELEVANCE The ideal construct stiffness required for the successful union after TMC joint arthrodesis is unknown, but HCS has the best overall biomechanical performance and, therefore, might be considered the best choice for this clinical setting.
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Affiliation(s)
- Ranjit Sehjal
- Tunbridge Wells Hospital, Tonbridge Road, Tunbridge Wells, United Kingdom.
| | - Wan Rusli
- Department of Bioengineering, Imperial College, London, United Kingdom (the work was carried out here)
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College, London, United Kingdom (the work was carried out here)
| | | | - Mark Williamson
- Queen Elizabeth Queen Mother Hospital, Margate, United Kingdom
| | - Andrew Smith
- Queen Elizabeth Queen Mother Hospital, Margate, United Kingdom
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Canton SP, Dadi S, Anthony A, Black RT, Clancy M, Fowler JR. Comparison of Screw Quantity and Placement of Metacarpal Fracture Fixation: A Biomechanical Study. Hand (N Y) 2022; 17:879-884. [PMID: 33349049 PMCID: PMC9465802 DOI: 10.1177/1558944720974116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is recommended to have 6 bicortical screws for plate fixation of long bone fractures; however, many metacarpal fractures do not allow 6 screws due to size limitations and proximity of crucial anatomical structures. The purpose of this biomechanical study was to determine whether the mechanical properties of a 4-screw nonlocking construct are noninferior to those of a 6-screw nonlocking construct. METHODS Metacarpal sawbones were used to simulate a midshaft, transverse fracture. Nonlocking bicortical screws were placed in the 6-hole plate, and the metacarpals were randomly assigned to 2 equal study groups: (1) 4 screws, 2 on either side of the fracture (4S); and (2) 6 screws, 3 on either side of the fracture (6S). The metacarpals were tested in a cyclic loading mode and load to failure in a cantilever bending mode. RESULTS Maximum deflection was significantly higher for 4S compared with 6S. Cyclic root mean square (RMS) was also significantly greater for 4S at 70 and 100 N. There were no statistically significant differences observed between the 2 constructs for maximum bending load, bending stiffness, and cyclic RMS at 40 N. The maximum bending load in 4S and 6S was 245.6 ± 37.9 N and 230.8 ± 41.9 N, respectively; 4S was noninferior and not superior to 6S. Noninferiority testing was inconclusive for bending stiffness. CONCLUSIONS A 4-screw bicortical nonlocking construct is noninferior to a 6-screw bicortical nonlocking construct for fixation of metacarpal fractures, which may be advantageous to minimize disruption of soft tissues while maintaining sufficient construct stability.
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Biehl C, Stötzel S, Schock L, Szalay G, Heiss C. Treatment of hand and finger fractures with the Stryker Hand Plating System. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc03. [PMID: 35465637 PMCID: PMC9006317 DOI: 10.3205/000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/01/2021] [Indexed: 11/18/2022]
Abstract
Objectives: 10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System. Patients and methods: Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters. Results: Three-quarters of the patients were male. The mean age at the time of surgery was 39.3±16 years. Falling was the leading cause for hand fractures, and the most common were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. Conclusion: The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. Level of Evidence: Level: IV; outcome-study, retrospective.
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Affiliation(s)
- Christoph Biehl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany,*To whom correspondence should be addressed: Christoph Biehl, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Rudolf-Buchheim-Str. 7, 35392 Gießen, Germany, E-mail:
| | - Sabine Stötzel
- Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Lydia Schock
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Gabor Szalay
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
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Chiu YC, Ho TY, Ting YN, Tsai MT, Huang HL, Hsu CE, Hsu JT. Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study. BMC Musculoskelet Disord 2021; 22:146. [PMID: 33546670 PMCID: PMC7866681 DOI: 10.1186/s12891-020-03939-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan, Republic of China, 433
| | - Heng-Li Huang
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, No. 1650, Sec. 4 Taiwan Boulevard, Situng Dist., Taichung City, 407, Taiwan (Republic of China). .,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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7
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Carreño A, Ansari MT, Malhotra R. Management of metacarpal fractures. J Clin Orthop Trauma 2020; 11:554-561. [PMID: 32684692 PMCID: PMC7355092 DOI: 10.1016/j.jcot.2020.05.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 11/26/2022] Open
Abstract
The metacarpal fractures are common fractures which are treated by orthopaedic surgeons, plastic surgeons and hand surgeons equally. These are seen in young adults who have active life style. These have a major impact in life style of the patients if these are not treated adequately. The management of the fractures vary among surgeons to surgeons; two surgeons in the same centre can have a different treatment plan for a fracture. There are no standard guidelines for the treatment and it ranges from conservative management, Kirschner's wire (K-wires), plates and screws. This review article is about the management of metacarpal fractures where the commonly done procedures are reviewed.
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Affiliation(s)
- Ana Carreño
- Hospital Clinic Barcelona, University of Barcelona, Kaplan Hand Institute, Barcelona, Spain
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India,Corresponding author.
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
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8
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Shanmugam R, Jian CYCCS, Haseeb A, Aik S. Comparing biomechanical strength of unicortical locking plate versus bicortical compression plate for transverse midshaft metacarpal fracture. J Orthop Surg (Hong Kong) 2019; 26:2309499018802511. [PMID: 30270746 DOI: 10.1177/2309499018802511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Studies have compared locking and compression plates. However, in these studies, the biomechanical properties were tested using the static loading method. This study looks into cyclical loading that is more representative of in vivo conditions, particularly for early rehabilitation. We compared the biomechanical strength of the unicortical locking plate and bicortical compression plate system in a transverse metacarpal fracture, tested with cyclical loading and torsion. METHOD Twenty pieces of fourth-generation, biomechanical testing grade, left third metacarpal composite bones were used. Resin was used to create the holding block at both ends of the bone. An oscillating saw with 0.8 mm thick saw blade was used to osteotomize the metacarpal sawbones to create a midshaft transverse metacarpal fracture model. Ten pieces were fixed with a 2.0 mm titanium locking plate via unicortical screw purchase and 10 were fixed with a 2.0 mm, four holes, titanium dynamic compression plate, bicortical purchase of screws. They were subjected to cyclic load to failure testing three-point bending and torsion. RESULTS There were no significant difference in stiffness and cyclic three-point bending to failure between the unicortical locking plate group and the bicortical compression plate group. The bicortical compression plate group is stiffer and has a higher cyclic bending load to failure as compared to the unicortical locking plate group. CONCLUSION Unicortical locking plate fixation of metacarpal fracture can be reliably applied clinically to produce a strong and stable construct that allows early mobilization of the joints. This will not only reduce the complication rate of metacarpal plating, but also improve the functional outcome of the hand.
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Affiliation(s)
| | | | | | - Saw Aik
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
PRACTICAL RELEVANCE Periarticular stifle fractures are uncommon but challenging injuries to treat. There may be concurrent damage to the ligaments and stabilising structures of the stifle joint itself, which should also be evaluated (see Part 1 of this article series). Improved knowledge of the fixation options and biomechanical challenges of these injuries will aid clinical decision-making and effective repair. CLINICAL CHALLENGES Due to their nature, periarticular fractures may have small juxta-articular fragments, which require additional thought to address during stabilisation. In juvenile animals, these fractures typically involve the physis and often can be managed with cross pin fixation. In adult cats, locking fixation, specialised plates or external skeletal fixators can be utilised to address the juxta-articular fragments. Readers should also be aware of patellar fracture and dental anomaly syndrome (PADS), where cats develop insufficiency fractures affecting the patella and proximal tibia. A careful oral examination should be performed in affected patients, as these cats may have persistent deciduous teeth. Close attention should be paid to preoperative radiographs for evidence of chronicity of the injury including sclerosis of the patella, remodelling and blunting of the fracture lines. AIMS The aims of the article are to review the current literature surrounding periarticular fractures of the stifle joint and to summarise the diagnosis, treatment, outcome and complications of each fracture type. As well as discussing general fracture fixation and biomechanical principles applicable to both dogs and cats, information is provided on specific issues facing cats, such as PADS. EVIDENCE BASE Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from a combination of the available literature and the authors' clinical experience.
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Affiliation(s)
- Alessandro Conte
- University of Glasgow Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary & Life Sciences, 464 Bearsden Road, Glasgow G61 1QH, UK
| | - Elena Addison
- University of Glasgow Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary & Life Sciences, 464 Bearsden Road, Glasgow G61 1QH, UK
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10
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Chiu YC, Tsai MT, Hsu CE, Hsu HC, Huang HL, Hsu JT. New fixation approach for transverse metacarpal neck fracture: a biomechanical study. J Orthop Surg Res 2018; 13:183. [PMID: 30045774 PMCID: PMC6060459 DOI: 10.1186/s13018-018-0890-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates. Methods We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types. Results The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm). Conclusion The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Horng-Chaung Hsu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan, Republic of China
| | - Heng-Li Huang
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, College of Dentistry, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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11
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Alwen SGJ, Kapatkin AS, Garcia TC, Milgram J, Stover SM. Open Screw Placement in a 1.5 mm LCP Over a Fracture Gap Decreases Fatigue Life. Front Vet Sci 2018; 5:89. [PMID: 29876361 PMCID: PMC5975469 DOI: 10.3389/fvets.2018.00089] [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: 01/08/2018] [Accepted: 04/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the influence of plate and screw hole position on the stability of simulated radial fractures stabilized with a 1.5 mm condylar locking compression plate (LCP). Study Design In vitro mechanical testing of paired cadaveric limbs. Sample Population Paired radii (n = 7) stabilized with a 1.5 mm condylar LCP with an open screw hole positioned either proximal to (PG), or over (OG), a simulated small fracture gap. Methods Constructs were cycled in axial compression at a simulated trot load until failure or a maximum of 200,000 cycles. Specimens that sustained 200,000 cycles without failure were then loaded in axial compression in a single cycle to failure. Construct cyclic axial stiffness and gap strain, fatigue life, and residual strength were evaluated and compared between constructs using analysis of variance. Results Of pairs that had a failure during cyclic loading, OG constructs survived fewer cycles (54,700 ± 60,600) than PG (116,800 ± 49,300). OG constructs had significantly lower initial stiffness throughout cyclic loading and higher gap strain range within the first 1,000 cycles than PG constructs. Residual strength variables were not significantly different between constructs, however yield loads occurred at loads only marginally higher than approximated trot loads. Fatigue life decreased with increasing body weight. Conclusion Fracture fixation stability is compromised by an open screw hole directly over a fracture gap compared to the open screw hole being buttressed by bone in the model studied. The 1.5 mm condylar LCP may be insufficient stabilization in dogs with appropriate radial geometry but high body weights.
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Affiliation(s)
- Sarah G J Alwen
- JD Wheat Veterinary Orthopedic Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.,ACCESS Specialty Animal Hospital, Culver City, CA, United States
| | - Amy S Kapatkin
- JD Wheat Veterinary Orthopedic Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.,Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Tanya C Garcia
- JD Wheat Veterinary Orthopedic Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.,Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Joshua Milgram
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susan M Stover
- JD Wheat Veterinary Orthopedic Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.,Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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12
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Ex vivo evaluation of the biomechanical effect of varying monocortical screw numbers on a plate-rod canine femoral gap model. Vet Comp Orthop Traumatol 2017; 26:177-85. [DOI: 10.3415/vcot-12-05-0061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To compare the biomechanical behaviour of plate-rod constructs with varying numbers of monocortical screws applied to an ex vivo canine femoral-gap ostectomy model.Sample population: Twenty Greyhound dog cadaveric femurs.Methods: Bone mineral density (BMD) was assessed with dual x-ray absorptiometry. Bones were assigned to four groups. Bones had a 12-hole 3.5 mm locking compression plate with one bicortical non-locking cortical screw in the most proximal and distal plate holes and an intramedullary Steinmann pin applied across a 20 mm mid-diaphyseal ostectomy. Additionally, one to four monocortical non-locking cortical screws were then placed (Groups 1–4 respectively) in the proximal and distal fragments. Stiffness and axial collapse were determined before and after cyclic axial loading (6000 cycles at 20%, 40%, and 60% of mean bodyweight [total: 18000 cycles]). Constructs subsequently underwent an additional 45000 cycles at 60% of bodyweight (total: 63000 cycles). Loading to failure was then performed and ultimate load and mode of failure recorded.Results: The BMD did not differ significantly between groups. Construct stiffness for group 1 was significantly less than group 4 (p = 0.008). Stiffness showed a linear increase with an increasing number of monocortical screws (p = 0.001). All constructs survived fatigue loading. Load-to-failure was not significantly different between groups. Mean load- to-failure of all groups was >1350N.Clinical relevance: Ex vivo canine large-breed femurs showed adequate stability biomechanically and gradually increasing stiffness with increasing monocortical screw numbers.
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Effect of monocortical and bicortical screw numbers on the properties of a locking plate-intramedullary rod configuration. Vet Comp Orthop Traumatol 2017; 29:459-465. [DOI: 10.3415/vcot-16-03-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: To evaluate the effect of varying the number and configuration of locking bicortical and monocortical screws on a plate-rod construct using a mid-diaphyseal femoral ostectomy model.Methods: Thirty Greyhound femurs were assigned to six groups (A-F). An intramedullary pin was placed in each bone following which a 3.5 mm locking plate was applied with six differing locking screw configurations. Groups A to C had one bicortical screw in the most proximal and distal plate holes and one to three monocortical locking screws in the proximal and distal fragments. Groups D to F had no bicortical screws placed and two to four monocortical locking screws in proximal and distal fragments. Each construct was axially loaded at 4 Hz from a preload of 10 Newtons (N) to 72 N, increasing to 144 N and 216 N, each of 6000 cycles with a further 45,000 cycles at 216 N to simulate a three to six week postoperative convalescence period. Constructs were then loaded to failure.Results: No construct suffered screw loosening or a significant change in construct stiffness during cyclic loading. There was no significant difference in load to failure of any construct (p = 0.34), however, less variation was seen with monocortical constructs. All constructs failed at greater than 2.5 times physiological load, and failure was by bending of the intramedullary pin and plate rather than screw loosening or pull-out.Clinical significance: Axially loaded locking monocortical plate-rod constructs applied to the canine femur may confer no difference biomechanically to those employing locking bicortical screws.
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Liodaki E, Wendlandt R, Waizner K, Schopp BE, Mailänder P, Stang F. A biomechanical analysis of plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to 4-point bending and dynamical bending test. Medicine (Baltimore) 2017; 96:e6926. [PMID: 28682860 PMCID: PMC5502133 DOI: 10.1097/md.0000000000006926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the published literature there are controversial data to the biomechanical stability of monocortical comparing to the bicortical fixation of metacarpal fractures. The aim of this study was to compare the biomechanical stability of monocortical and bicortical locking osteosynthesis in quasi-static and dynamic 4-point bending tests of composite third metacarpal bone (4th Gen third metacarpal, Sawbones, Malmö, Sweden) fixed with 7-hole locking plate (XXS System, Biotech-Ortho, Wright, Memphis, TN). The tests to determine quasi-static yield and bending strength as well as fatigue strength were conducted in 4 groups of 10 samples after creating standardized mid-shaft transverse osteotomies using a diamont belt grinder (0.3 mm saw blade). The force applied was the dorsal apex loading, similar to the forces applied to metacarpals during normal finger flexion and extension.In the quasi-static testing, no plate breakage was observed in each group. All metacarpals broke at their thinnest part. The average bending strength of the bicortical samples (10.54 ± 0.998 Nm) was significantly higher comparing to the monocortical samples (8.57 ± 0.894 Nm) (P < .001).In the dynamic loading test, all constructs (8 monocortical samples and 7 bicortical) that failed broke at the osteotomy site and the average fatigue strength did not differ in both groups.Consequently, a unicortical plating method may provide adequate strength and stability to metacarpal fractures based on the results of the cyclical loading representative of in vivo loading.
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Affiliation(s)
- Eirini Liodaki
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Robert Wendlandt
- Laboratory for Biomechanics, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Klaus Waizner
- Laboratory for Biomechanics, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Brigitte E. Schopp
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Peter Mailänder
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Felix Stang
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
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Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study. J Hand Surg Am 2017; 42:392.e1-392.e6. [PMID: 28359640 DOI: 10.1016/j.jhsa.2017.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/24/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. METHODS Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. RESULTS Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). CONCLUSIONS Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. CLINICAL RELEVANCE Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
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Comparison of 2-Dimensional and 3-Dimensional Metacarpal Fracture Plating Constructs Under Cyclic Loading. J Hand Surg Am 2017; 42:e159-e165. [PMID: 28259280 DOI: 10.1016/j.jhsa.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/26/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Metacarpal fractures are commonly treated by a variety of means including casting or open reduction internal fixation when unacceptable alignment is present following attempted closed reduction. Dorsal plating with either single-row 2-dimensional or double-row 3-dimensional plates has been proposed. This study's purpose was to determine if there are any differences in fixation construct stability under cyclic loading and subsequent load to failure between the lower profile 3-dimensional and the larger 2-dimensional plates in a metacarpal fracture gap sawbone model. METHODS Thirty metacarpal cortico-cancellous synthetic bones were cut with a 1.75-mm gap between the 2 fragments simulating mid-diaphyseal fracture comminution. Half of the metacarpals were plated with 2.0-mm locking 2-dimensional plates and half with 1.5-mm locking 3-dimensional plates. The plated metacarpals were mounted into a materials testing apparatus and cyclically loaded under cantilever bending for 2,000 cycles at 70 N, then 2,000 cycles at 120 N, and finally monotonically loaded to failure. Throughout testing, fracture gap sizes were measured, failure modes were recorded, and construct strength and stiffness values were calculated. RESULTS All 3-dimensional constructs survived both cyclic loading conditions. Ten (67%) 2-dimensional constructs survived both loading conditions, whereas 5 (33%) failed the 120-N loading at 1377 ± 363 cycles. When loaded to failure, the 3-dimensional constructs failed at 265 N ± 21 N, whereas the 2-dimensional constructs surviving cyclic loading failed at 190 N ± 17 N. CONCLUSIONS The shorter, thinner 3-dimensional metacarpal plates demonstrated increased resistance to failure in a cyclic loading model and increased load to failure compared with the relatively longer, thicker 2-dimensional metacarpal plates. CLINICAL RELEVANCE The lower-profile 3-dimensional metacarpal plate fixation demonstrated greater stability for early postoperative resistance than the thicker 2-dimensional fixation, whereas the smaller size and lower profile of the 3-dimensional plates potentially reduces soft tissue stripping, implant prominence, and risk of extensor tendon irritation.
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Al-Madawy AM, Elatta MMA, Hasanin MM, Al-Nahal AAEK. The Use of Minilocked Plate for Management of Unstable Metacarpal Fractures. J Hand Microsurg 2016; 8:159-164. [PMID: 27999459 DOI: 10.1055/s-0036-1593730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022] Open
Abstract
Objective This study aims to evaluate the use of minilocked plates in the treatment of the metacarpal fractures. Method A total of 30 patients of metacarpal fractures were treated by minilocked plates. Results Union was achieved in all patients. There were 27 (90%) patients having satisfactory results (excellent and good results) and 3 patients (10%) had poor results. Conclusion The use of minilocked plate is recommended for fixation of periarticular, comminuted, and osteoporotic metacarpal fractures that offer rigid fixation early mobilization, decreases the incidence of joints stiffness, and tendon adherence which maximized the hand function.
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Extensor tendon splitting versus extensor tendon sparing approach for miniplate fixation of extraarticular proximal phalangeal fractures. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stability of Unicortical versus Bicortical Metacarpal Fracture Internal Fixation Trial (SUBMIT): study protocol for a randomized controlled trial. Trials 2016; 17:411. [PMID: 27538992 PMCID: PMC4991012 DOI: 10.1186/s13063-016-1538-3] [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: 11/26/2015] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metacarpal fractures are common, accounting for 40 % of all hand injuries. The use of plates for the fixation of these fractures allows early aggressive hand therapy post-operatively, reducing post-operative stiffness. Traditionally, bicortical fixation is the standard practice, where both dorsal and palmar cortices of the metacarpal are drilled through, with screws engaging both cortices. Recent biomechanical studies have shown that unicortical fixation, where only the near cortex is drilled and engaged by the screw, results in no difference in stiffness, load to failure or failure mechanism, when compared with bicortical fixation. This trial aims to compare fracture union, complication rate and functional outcomes between unicortical and bicortical fixation for adults with displaced metacarpal fractures. METHODS/DESIGN All adults with displaced diaphyseal metacarpal fracture requiring plate fixation are potentially eligible to take part in this study. A total of 315 consenting patients will be randomly allocated to either unicortical or bicortical plate and screw fixation. The surgery will be performed in specialist hand trauma units across the UK. Data regarding fracture healing, hand function, quality of life, and complications will be collected at 2 weeks, 6 weeks and 6 months following surgery. DISCUSSION This pragmatic, prospective, multi-centre, randomized controlled trial is expected to deliver results in 2018. TRIAL REGISTRATION ISRCTN 18006607 . Registered on 19 Nov 2015.
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Curtis BD, Fajolu O, Ruff ME, Litsky AS. Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed K-Wires and Plate-Screw Constructs. Orthop Surg 2016; 7:256-60. [PMID: 26311101 DOI: 10.1111/os.12195] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Metacarpal (MC) fractures are very common, accounting for 18% of all fractures distal to the elbow. Many MC fractures can be treated non-operatively; however, some are treated most effectively with surgical stabilization, for which there are multiple methods. It was postulated that plates would have a significantly higher (P < 0.05) load to failure than crossed K(XK)-wires and that intramedullary metacarpal nails (IMNs) and XK-wires would have equivalent load to failure. METHODS Mid-diaphyseal transverse fractures were created in 36 synthetic metacarpals and stabilized using nails, XK-wires or non-locking plates. Three-point bending was performed with continuous recording of load and displacement. Statistical analysis was performed using single factor ANOVA and Scheffe's test. Statistical significance was defined as P < 0.05. RESULTS Biomechanical testing revealed significant differences between groups in load-to-failure. Average load to failure was significantly greater in the plate (1669 ± 322 N) than the XK-wire (146 ± 56 N) or IMN (110 ± 43 N) groups. The loads to failure of the K-wires and nails were equivalent. Plates were 11 and 15 times stronger in three-point bending than the K-wires and nails, respectively. There was no statistically significant difference between strengths of the K-wires and nails. CONCLUSIONS Although plates are the most stable means of fixation of midshaft metacarpal fractures, if minimally-invasive techniques are indicated, intramedullary nails may provide equivalent stability as commonly-used XK-wires. Although some studies have shown favorable clinical outcomes with IMNs, additional clinical correlation of these biomechanical results to fracture healing and outcomes is needed.
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Affiliation(s)
- Benjamin D Curtis
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Olukemi Fajolu
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Michael E Ruff
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Alan S Litsky
- Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
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Dickson JK, Bhat W, Gujral S, Paget J, O'Neill J, Lee SJ. Unicortical fixation of metacarpal fractures: is it strong enough? J Hand Surg Eur Vol 2016. [PMID: 26205897 DOI: 10.1177/1753193415594570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Unicortical fixation has some practical and theoretical advantages over bicortical fixation. Questions have been raised to its adequacy for post-operative mobilization. We hypothesized that fixation using a plate and eight unicortical screws would be as strong as using a plate and four bicortical screws. A total of 40 unicortical and 40 bicortical fixations were compared using a cadaveric metacarpal model. Unicortical fixation was performed using an eight-hole parallel plate and bicortical fixation with a four-hole straight plate. Fixations were tested to failure using four-point bending load. The mean load to failure was 414 N SD 38(SE) for the unicortical group and 296 N SD 29(SE) for the bicortical group. Significant differences between these two constructs were observed. The mean stiffness of the fixation was higher for the bicortical group than the unicortical, although this difference did not reach significance. Unicortical fixation alone is sufficient to enable early post-operative mobilization in a live model.
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Affiliation(s)
- J K Dickson
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - W Bhat
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - S Gujral
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - J Paget
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - J O'Neill
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
| | - S J Lee
- Department of Plastic Surgery, Frenchay Hospital, Bristol, UK
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Malasitt P, Owen JR, Tremblay MA, Wayne JS, Isaacs JE. Fixation for metacarpal neck fracture: a biomechanical study. Hand (N Y) 2015; 10:438-43. [PMID: 26330775 PMCID: PMC4551637 DOI: 10.1007/s11552-015-9744-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is no robust evidence of the best operative treatment for displaced unstable metacarpal neck fractures. Numerous constructs are used in the fixation of metacarpal neck fractures. Currently, two common methods are dorsal locking plate and K-wire fixation. A new metacarpal sled fixation system for metacarpal neck fracture was designed to provide fracture stability but limit dissection and avoid exposed hardware. The purpose of this study was to compare the biomechanical integrity of the metacarpal sled versus standard locking plate fixation and retrograde K-wire fixation in a simulated porcine metacarpal fracture model. METHODS Transverse metacarpal neck fractures were created in 30 porcine second metacarpals. The specimens were randomly fixed with locking plates, metacarpal sleds, or retrograde K-wires. Constructs were then loaded to failure in three-point bending. Stiffness and peak load were measured from the load-to-failure deflection curve. Data were analyzed via ANOVA, followed by Tukey-Kramer's post hoc pairwise comparison. RESULTS The K-wire group had the highest initial stiffness followed by the sled group and then the plate group. Statistical difference was only found between K-wires and plate. Peak load for the K-wire group was lowest, followed by sled, and then by plate. A statistically significant difference was observed between the peak loads of the K-wires and plate, as well as the sled and plate. However, a difference in peak load was not detected between the K-wires and sled. CONCLUSIONS For transverse metacarpal neck fractures, a metacarpal sled construct provides similar fixation to K-wires with limited dissection and without exposed hardware or the potential for soft tissue tethering. The new low profile construct using a minimally invasive technique would be suitable for unstable metacarpal neck fractures.
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Affiliation(s)
- Pramote Malasitt
- />Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - John R. Owen
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Marc-Antoine Tremblay
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Jennifer S. Wayne
- />Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA 23298-0153 USA
| | - Jonathan E. Isaacs
- />Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, P.O. Box 980153, Richmond, VA 23298-0153 USA
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Unicortical PEEK inset locking fixation for metacarpal fractures: a biomechanical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 24:1415-20. [PMID: 24121825 DOI: 10.1007/s00590-013-1322-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/24/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE There are numerous constructs employed in the treatment of metacarpal fractures with varying degrees of success. While plate fixation commonly involves dorsal application of a bicortical non-locking plate, there has been recent exploration of other fixation options including unicortical locked plating. The purpose of this study was to evaluate the biomechanical integrity of a polyetheretherketone (PEEK) inset locking plate and, in doing so, compare it to standard plate fixation (utilizing a clinically proven bicortical non-locking titanium plate) in a simulated porcine metacarpal fracture model. METHODS Reproducible mid-shaft fractures were created in porcine second metacarpals. The fractured specimens were reduced and plated with either a bicortical non-locking plate or a unicortical locking plate with a PEEK locking design. Constructs were then loaded to failure in the same fashion as performed to create the fracture. Peak load was measured as the apex on the load-to-failure deflection curve. Stiffness was calculated as the linear slope on the load-to-failure deflection curve. Data were analyzed via Student's t test. RESULTS Unicortical locking constructs failed at 344 ± 119 N, while bicortical non-locking constructs were found to fail at 277 ± 101 N (p = 0.19). The unicortical locking constructs demonstrated a stiffness of 80 ± 36 N/mm compared with the bicortical non-locking constructs (69 ± 36 N/mm) although again the difference was not found to be statistically different (p = 0.49). CONCLUSION Based on this study, a locked plating construct using a polymer mechanism provides an interesting new locking fixation method for small bone fractures and with our limited number of specimens tested, provided at least a similar strength and rigidity profile in comparison with bicortical fixation in the treatment of metacarpal fractures.
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Biomechanical analysis of the efficacy of locking plates during cyclic loading in metacarpal fractures. ScientificWorldJournal 2014; 2014:648787. [PMID: 24757429 PMCID: PMC3976824 DOI: 10.1155/2014/648787] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/19/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyse the biomechanical characteristics of locking plates under cyclic loading compared to a nonlocking plate in a diaphyseal metacarpal fracture. METHODS Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. An anatomical reduction and stabilization with a nonlocking and a comparable locking plate in mono- or bicortical screw fixation followed. Under cyclic loading, the displacement, and in subsequent load-to-failure tests, the maximum load and stiffness were measured. RESULTS For the monocortical screw fixation of the locking plate, a similar displacement, maximum load, and stiffness could be demonstrated compared to the bicortical screw fixation of the nonlocking plate. CONCLUSIONS Locking plates in monocortical configuration may function as a useful alternative to the currently common treatment with bicortical fixations. Thereby, irritation of the flexor tendons would be avoided without compromising the stability, thus enabling the necessary early functional rehabilitation.
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Barr C, Behn AW, Yao J. Plating of metacarpal fractures with locked or nonlocked screws, a biomechanical study: how many cortices are really necessary? Hand (N Y) 2013; 8:454-9. [PMID: 24426966 PMCID: PMC3840765 DOI: 10.1007/s11552-013-9544-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dorsal plate and screw fixation is a popular choice for metacarpal stabilization. The balance between construct stability and soft tissue dissection remains a surgical dilemma. Historically, six cortices of bone fixation on either side of a fracture were deemed necessary. This study aims to elucidate whether four cortices of locked fixation on either side of the fracture is equivalent to the current gold standard of six cortices of nonlocked fixation on either side of the fracture. If so, less dissection to insert shorter plates with fewer screws could be used to stably fix these fractures. METHODS With biomechanical testing-grade composite Sawbones, a comminuted metacarpal fracture model was used to test two fixation constructs consisting of a standard dorsal plate and either six bicortical nonlocking screws (three screws per segment) or four bicortical locking screws (two screws per segment). Thirty specimens were tested to failure in cantilever bending and torsion. RESULTS There was statistical equivalence between the locking and nonlocking constructs in cantilever bending stiffness, torsional stiffness, maximum bending load, and maximum torque. CONCLUSION The tested metacarpal fracture model had equivalent biomechanical properties when fixed with a standard dorsal plate and either six bicortical nonlocking screws or four bicortical locking screws. By utilizing fewer cortices of fixation, there will be less dissection and less soft tissue stripping during fixation of metacarpal fractures. This will also be of benefit in very proximal or distal fractures as multiple cortices of fixation are often difficult to obtain during stabilization of these challenging fractures.
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Affiliation(s)
- Cameron Barr
- />Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA USA
| | - Anthony W Behn
- />Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA USA
| | - Jeffrey Yao
- />Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA USA
- />450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342 USA
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Abstract
Multiple options are available for the fixation of metacarpal and phalangeal fractures; treatment options depend largely on the fracture characteristics, concomitant injuries, and surgeon preference. With an understanding of the options available and the biomechanics involved, appropriate treatment options may be chosen. Although plate and screw constructs provide the strongest fixation for these fractures, many other techniques provide adequate fixation and may be favored for reasons other than biomechanics.
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Affiliation(s)
- Julie E Adams
- Department of Orthopaedic Surgery, The University of Minnesota, 2450 Riverside Avenue R200, Minneapolis, MN 55454, USA
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Kim MB, Lee YH, Kim JH, Baek GH, Lee JE. Biomechanical comparison of three 2.7-mm screws and two 3.5-mm screws for fixation of simple oblique fractures in human distal fibulae. Clin Biomech (Bristol, Avon) 2013. [PMID: 23182549 DOI: 10.1016/j.clinbiomech.2012.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fixation of simple oblique fractures of short tubular bones with only inter-fragmentary screws is simple and clinically useful. This study compared the biomechanical properties of fixation using three 2.7-mm mini-screw and two conventional 3.5-mm lag screw constructs for simple oblique fractures of the distal fibula in human osteoporotic bone. METHODS Simple oblique fractures of the distal fibula at the level of the syndesmosis were simulated in 15 paired fresh frozen ankles, and the calcaneal bone mineral density was measured in each. Fixation with either three 2.7-mm mini-screws (new system) or two 3.5-mm cortical screws (conventional system) was performed in each pair of ankles. The sample size for each type of stress (cantilever bending stress, five pairs; external rotational load to failure, 10 pairs) was calculated before the test. The biomechanical variables (maximal failure load and construct stiffness) of the two fixation groups were compared using a non-inferiority test method with a pre-specified non-inferiority margin. FINDINGS The bone mineral density of the calcaneus was assessed as osteoporotic based on reference values for 20- to 29-year-old healthy Koreans. The new system was not inferior to the conventional system in terms of the tested biomechanical properties. The construct failure was initiated from the distal-most screw hole in the anterior cortex. INTERPRETATION Fixation with only three 2.7-mm mini-screws provided biomechanical stability comparable to two 3.5-mm cortical screws for simple oblique osteoporotic fractures in the distal fibula under one-shot stress. Mini-screw application for this common fracture might extend the scope of surgical indications for the screws-only fixation method.
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Affiliation(s)
- Min Bom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Republic of Korea
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Afshar R, Fong TS, Latifi MH, Kanthan SR, Kamarul T. A biomechanical study comparing plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to cyclic loading. J Hand Surg Eur Vol 2012; 37:396-401. [PMID: 22019989 DOI: 10.1177/1753193411424557] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The use of bicortical screws to fix metacarpal fractures has been suggested to provide no added biomechanical advantage over unicortical screw fixation. However, this was only demonstrated in static loading regimes, which may not be representative of biological conditions. The present study was done to determine whether similar outcomes are obtained when cyclic loading is applied. Transverse midshaft osteotomies were created in 20 metacarpals harvested from three cadavers. Fractures were stabilised using 2.0 mm mini fragment plates fixed with either bicortical or unicortical screw fixation. These fixations were tested to failure with a three-point bending cyclic loading protocol using an electromechanical microtester and a 1 kN load cell. The mean load to failure was 370 N (SD 116) for unicortical fixation and 450 N (SD 135) for bicortical fixation. Significant differences between these two constructs were observed. A biomechanical advantage was found when using bicortical screws in metacarpal fracture plating.
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Affiliation(s)
- R Afshar
- Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model. INTERNATIONAL ORTHOPAEDICS 2012; 36:1641-6. [PMID: 22426933 DOI: 10.1007/s00264-012-1524-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to determine the biomechanical characteristics of locking plates with the TriLock system with different design and screw settings compared to a non-locking plate in a diaphyseal metacarpal fracture. METHODS Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. After reduction they were fixed with three different locking plates with the TriLock interlocking mechanism or a non-locking linear plate in mono- or bicortical screw fixations. In load to failure tests the maximum load and stiffness were measured. RESULTS For linear plates, the maximum load was higher for the non-locking plate compared with the locking plate. The maximum load could be increased for the locking plates using a double-row design and a higher screw number. No differences were found for the stiffness between all groups. In contrast to the non-locking plate, the mode of failure of the locking plates in many cases (86 %) was a loss of the interlocking mechanism. CONCLUSIONS The results suggest that the locking plates with the TriLock system achieve no higher stability compared to a non-locking plate in load to failure tests. Adaptions to increase the stability of the interlocking mechanism are desirable.
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Yaffe MA, Saucedo JM, Kalainov DM. Non-locked and locked plating technology for hand fractures. J Hand Surg Am 2011; 36:2052-5. [PMID: 22037299 DOI: 10.1016/j.jhsa.2011.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/15/2011] [Accepted: 09/22/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Mark A Yaffe
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Zahn R, Frey S, Moritz M, Waschke J, Schneider P, Meffert R. Die Supinations-Eversions-Verletzung des OSG in osteoporotischen Unterschenkelpräparaten. Unfallchirurg 2011; 114:697-704. [DOI: 10.1007/s00113-011-2004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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