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Gorgy A, Dalfen J, Barone N, Efanov JI. Non-steroidal anti-inflammatory drugs in postoperative hand fracture management: Do they positively or negatively impact recovery? World J Clin Cases 2024; 12:4856-4858. [PMID: 39070820 PMCID: PMC11235475 DOI: 10.12998/wjcc.v12.i21.4856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024] Open
Abstract
This editorial explores the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on postoperative recovery in hand fracture patients, amidst shifting pain management strategies away from opioids due to their adverse effects. With hand fractures being significantly common and postoperative pain management crucial for recovery, the potential of NSAIDs offers a non-addictive pain control alternative. However, the controversy over NSAIDs' effects on bone healing-stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union-necessitates further investigation. Despite a comprehensive literature search, the study finds a lack of specific research on NSAIDs in postoperative hand fracture management, highlighting an urgent need for future studies to balance their benefits against possible risks.
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Affiliation(s)
- Andrew Gorgy
- Department of Plastic, Reconstructive, and Aesthetic Surgery, McGill University, Montreal H4A 3J1, QC, Canada
| | - Jacqueline Dalfen
- Faculty of Medicine and Health Sciences, McGill University, Montreal H4A 3J1, QC, Canada
| | - Natasha Barone
- Department of Plastic and Reconstructive Surgery, University of Toronto, Toronto M5S 1A1, ON, Canada
| | - Johnny Ionut Efanov
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier de l’Université de Montréal, Montreal H2X 3E4, QC, Canada
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2
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Tan X, Ahmed-Kristensen S, Zhu Q, Han T, Zhu L, Chen W, Cao J, Nanayakkara T. Identification of excessive contact pressures under hand orthosis based on finite element analysis. Prosthet Orthot Int 2024:00006479-990000000-00249. [PMID: 38771762 DOI: 10.1097/pxr.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/15/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Implicit magnitudes and distribution of excessive contact pressures under hand orthoses hinder clinicians from precisely adjusting them to relieve the pressures. To address this, contact pressure under a hand orthosis were analysed using finite element method. METHODS This paper proposed a method to numerically predict the relatively high magnitudes and critical distribution of contact pressures under hand orthosis through finite element analysis, to identify excessive contact pressure locations. The finite element model was established consisting of the hand, orthosis and bones. The hand and bones were assumed to be homogeneous and elastic bodies, and the orthosis was considered as an isotropic and elastic shell. Two predictions were conducted by assigning either low (fat) or high (skin) material stiffness to the hand model to attain the range of pressure magnitudes. An experiment was conducted to measure contact pressures at the predicted pressure locations. RESULTS Identical pressure distributions were obtained from both predictions with relatively high pressure values disseminated at 12 anatomical locations. The highest magnitude was found at the thumb metacarpophalangeal joint with the maximum pressure range from 13 to 78 KPa. The measured values were within the predicted range of pressure magnitudes. Moreover, 6 excessive contact pressure locations were identified. CONCLUSIONS The proposed method was verified by the measurement results. It renders understanding of interface conditions underneath the orthosis to inform clinicians regarding orthosis design and adjustment. It could also guide the development of 3D printed or sensorised orthosis by indicating optimal locations for perforations or pressure sensors.
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Affiliation(s)
- Xinyang Tan
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | | | - Qian Zhu
- Department of Rehabilitation Medicine, The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ting Han
- School of Design, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhu
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Wei Chen
- Department of Rehabilitation Medicine, The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiangang Cao
- Department of Assistive Technology, International University of Health and Welfare, Otawara, Japan
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Abbot H, George AR, McCarron L, Graham DJ, Sivakumar B. Intramedullary Screw Fixation of Proximal Phalangeal Fractures: Short- to Medium-term Outcomes. Hand (N Y) 2024:15589447241235339. [PMID: 38491777 DOI: 10.1177/15589447241235339] [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: 03/18/2024]
Abstract
BACKGROUND Intramedullary screw fixation of phalangeal and metacarpal fractures has gained popularity as a method of providing rigid internal fixation with minimum tendon disturbance, allowing early mobilization and rehabilitation. Despite this, the literature on outcomes using this technique is limited. Thus, the aim of this study was to assess the short-term to medium-term outcomes of intramedullary screw fixation for proximal phalangeal fracture fixation in an Australian setting. METHODS A retrospective analysis of consecutive patients with a fracture(s) of the proximal phalanx fixated using intramedullary screws between January 2020 and March 2023 was conducted via telehealth. RESULTS Forty-six phalangeal fractures from 37 patients were included in this study. Mean Quick Disabilities of the Arm, Shoulder, and Hand score of 6.2 (range: 0-61.4, median: 0), mean pain visual analogue scale score of 1.8 (range: 1-7, median: 1), and mean total active motion of 231° (range: 132-282) were noted. A total of 4.4% of fractures sustained a major complication, and 94.6% of patients reported willingness to undergo intramedullary screw fixation again. CONCLUSION This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. Superior clinical outcomes, as well as cost-effectiveness and time-effectiveness, render it a viable alternative to plate fixation in this setting.
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Affiliation(s)
- Hagen Abbot
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adam R George
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Herston, Australia
| | - Brahman Sivakumar
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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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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5
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Thomas TL, Muchintala R, Crutchfield CR, Plusch K, Jones CM, Ilyas AM. Outcomes Following Fully Threaded Intramedullary Nailing of Metacarpal Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:85-90. [PMID: 38313619 PMCID: PMC10837302 DOI: 10.1016/j.jhsg.2023.10.003] [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: 07/09/2023] [Accepted: 10/14/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Intramedullary screw fixation has emerged as a popular approach for the treatment of displaced metacarpal fractures. The purpose of this study was to investigate the functional and radiographic outcomes of a newly designed, headless noncompressive fully threaded intramedullary nail (TIMN) for the treatment of metacarpal fractures. Methods A retrospective chart review was performed on patients who were treated with the INnate TIMN (ExsoMed) at a single academic institution with a minimum of 1-year follow-up. Patient-reported functional outcomes included Quick Disabilities for the Arm, Shoulder, and Hand (QuickDASH) questionnaires, return to work and physical activity time, and overall satisfaction. Radiographs were retrospectively reviewed to determine radiographic union, change in angulation, and metacarpal shortening. Results A total of 49 patients (58 fractures) with a mean age of 36 years (range: 17-75 years) were included. The mean follow-up time was 2.7 years (range: 1.4-4.3 years). Overall, the mean patient satisfaction rating was 4.9 of 5 (range: 3-5). The mean return to work time was 7.2 weeks (range: 0.14-28 weeks), and the mean return to sport or activity was 8.3 weeks (range: 1-28 weeks). Average QuickDASH scores across all patients were 4 (range: 0-56.9). The median radiographic healing time was 6.1 weeks (range: 4.7-15.4 weeks). Mean postoperative shortening in the fifth metacarpal fracture was 3 mm (range: -4.2 to 8 mm) at the initial postoperative visit and 3.6 mm (range: -3.3 to 7.9 mm) at the final radiographic follow-up. Subgroup analysis showed that postoperative shortening was similar, regardless of the fracture pattern. The following four complications were reported: one case of persistent pain and stiffness, one case of carpal tunnel syndrome, one nonunion, and one fractured intramedullary nail. Conclusions Our findings suggest that the TIMN allows for a reliable return to work and physical activity, high patient satisfaction, low complication rate, and minimal shortening at the final radiographic follow-up. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | - Rahul Muchintala
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Kyle Plusch
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Asif M. Ilyas
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Cavalcanti Kussmaul A, Kuehlein T, Langer MF, Ayache A, Unglaub F. The Treatment of Closed Finger and Metacarpal Fractures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:855-862. [PMID: 37963039 PMCID: PMC10840131 DOI: 10.3238/arztebl.m2023.0226] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures. METHODS This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature. RESULTS The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis. CONCLUSION Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
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Affiliation(s)
- Adrian Cavalcanti Kussmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Titus Kuehlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich
| | - Martin F. Langer
- Dept. for Trauma, Hand and Reconstructive Surgery, University Hospital of Muenster, Muenster
| | - Ali Ayache
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Clinic, Bad Rappenau
- Mannheim Faculty of Medicine of the Ruprecht-Karls Heidelberg University, Mannheim
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Thomas TL, Kachooei AR, Ilyas AM. Intramedullary K-wires versus Alternate Techniques for Metacarpal Shaft and Neck Fractures: A Systematic Review and Meta-analysis. J Hand Microsurg 2023; 15:376-387. [PMID: 38152671 PMCID: PMC10751204 DOI: 10.1055/s-0042-1749410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/ quick DASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time ( p = 0.04; mean difference = - 13; 95% confidence interval = -26 to -0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.
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Affiliation(s)
- Terence L. Thomas
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Amir R. Kachooei
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
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8
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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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9
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Ma X, Wang L, Zhang X, Zhang Z, Xu Y, Lv L, Shao X. Comparative study of K-wire combined with screw vs. K-wire in the treatment of AO type B3.1 phalangeal fractures. BMC Musculoskelet Disord 2023; 24:591. [PMID: 37468856 DOI: 10.1186/s12891-023-06731-0] [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] [Received: 01/04/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The purpose of this study was to introduce the surgical method of K-wire combined with screw in the treatment of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type B3.1 phalangeal fractures and to compare its clinical, radiological and functional outcomes with K-wire fixation. METHODS This was a retrospective comparative study. From January 2015 to February 2022, we treated 86 patients with AO type B3.1 phalangeal fractures. A total of 71 patients were finally included in the statistical analysis. Thirty-nine patients received K-wires combined with screw, and 32 patients received simple K-wires. The follow-up time was at least 6 months. Outcome measures included general information, operative time, total active motion (TAM), pinch strength, radiological union time, pain assessed by visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, cost, and complications. RESULTS The follow-up time was 6-12 months, with an average of 7.9 months. All patients achieved clinical and radiological union. Compared with the K-wire fixation group, the TAM, radiological union time and VAS score of the K-wire combined with screw group had obvious advantages. Compared with the opposite healthy hand, the grip strength of the two groups was similar, and there was no significant difference in the QuickDASH score. The incidence rate of complications in the K-wire combined with screw group (2/39) was lower than that in the K-wire fixation group (7/32). CONCLUSIONS Compared with simple K-wire fixation, K-wire combined with screw in the treatment of AO type B3.1 phalangeal fractures is a safer and reliable surgical method. K-wire controls the rotation and plays a role similar to a "lock". The screw can exert pressure and fix it more firmly. It shortens the time of fracture healing and has a higher TAM and fewer postoperative complications.
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Affiliation(s)
- Xuelin Ma
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Wang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaoran Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhemin Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yali Xu
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Lv
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xinzhong Shao
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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10
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Sivakumar BS, Vaotuua DL, McCarron L, Graham DJ. Cost Analysis of Intramedullary Screw versus Plate Osteosynthesis for Phalangeal and Metacarpal Fractures: An Observational Study. J Hand Surg Asian Pac Vol 2023; 28:369-376. [PMID: 37173145 DOI: 10.1142/s242483552350039x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).
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Affiliation(s)
- Brahman S Sivakumar
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
- Discipline of Surgery, the Faculty of Medicine and Health, Sydney Medical School, the University of Sydney, Camperdown, NSW, Australia
| | - Darren L Vaotuua
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - Luke McCarron
- Bond University Occupational Therapy Department, Robina, QLD, Australia
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine and Dentistry, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
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11
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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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12
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Lim Z, Foo ATL, Das De S. Surgical Technique: Lateral Plate Osteosynthesis of Proximal Phalanx Fractures. Tech Hand Up Extrem Surg 2023; 27:38-44. [PMID: 36040077 DOI: 10.1097/bth.0000000000000407] [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: 11/25/2022]
Abstract
Dorsal plate fixation of proximal phalanx (PP) fractures is a conventional approach but interferes with the extensor mechanism and results in stiffness. Biomechanical studies have shown that laterally placed plates on the proximal phalanges are equally stable and rigid. This technique obviates the issue of tendon adhesion and may result in better postoperative range of motion and lower secondary procedures such as removal of implant and tenolysis. The low adoption of this technique may be related to lack of familiarity with the surgical approach. We describe our surgical technique with lateral plating of PP fractures and present our case that lateral plate osteosynthesis is an acceptable surgical fixation option for PP fractures, which extends the hand surgeon's armamentarium for more challenging and comminuted fractures.
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Affiliation(s)
- Zhixue Lim
- Department of Hand & Reconstructive Microsurgery. University Orthopaedics, Hand & Reconstructive Microsurgery Cluster National University Health System
| | | | - Soumen Das De
- Department of Hand & Reconstructive Microsurgery. University Orthopaedics, Hand & Reconstructive Microsurgery Cluster National University Health System
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Biasini NR, Bannon B, Pellegrino M, Qaderi A, Trinh W, Switzer-McIntyre S, Reid WD, Kasawara KT. Reliability and Validity of Shoulder and Handgrip Strength Testing. Physiother Can 2023; 75:65-71. [PMID: 37250730 PMCID: PMC10211387 DOI: 10.3138/ptc-2021-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2024]
Abstract
Purpose: This study aimed to estimate the intra- and inter-rater reliability of the JTECH computerized, wireless apparatus and its validity (compared to established devices) for measurements of maximal shoulder isometric strength and handgrip strength among healthy adults with no shoulder pathology. Methods: Twenty healthy young adults had shoulder strength tested with JTECH and Micro-FET2 hand-held dynamometers, and the handgrip strength was tested using JTECH and Jamar handgrip dynamometers. Assessments were performed by the same rater to determine intra-rater reliability and convergent validity, at least two days apart, while on a third visit, the other rater performed measures to determine inter-rater reliability. Results: The JTECH computerized, wireless devices demonstrated good to excellent intra-rater reliability (ICCs (2,1) = 0.78-0.97) and inter-rater reliability for strength measures (ICCs (2,1) = 0.76-0.95). The JTECH computerized device compared to the Micro-FET2 hand-held dynamometer showed substantial concurrent validity for shoulder flexion (R2 = 0.87), extension (R2 = 0.87), abduction (R2 = 0.88), and adduction (R2 = 0.85). Substantial concurrent validity was shown for the JTECH computerized device and Jamar handgrip dynamometers (R2 = 0.92). Conclusions: The JTECH computerized, wireless devices demonstrated high intra- and inter-rater reliability and substantial concurrent validity for shoulder isometric strength and handgrip strength in healthy adults.
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Affiliation(s)
| | - Brian Bannon
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Michael Pellegrino
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Qaderi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - William Trinh
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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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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15
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Allen ST, Wang OJ, Erickson LO, Ward CM. Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures. Hand (N Y) 2023; 18:61-66. [PMID: 33834894 PMCID: PMC9806539 DOI: 10.1177/15589447211003181] [Citation(s) in RCA: 1] [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: 01/05/2023]
Abstract
BACKGROUND This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. METHODS We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. RESULTS Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. CONCLUSIONS We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.
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Affiliation(s)
| | | | | | - Christina M. Ward
- University of Minnesota, Minneapolis,
USA
- Regions Hospital, Saint Paul, MN,
USA
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16
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Sivakumar BS, An VVG, Symes MJ, Graham DJ, Lawson RD, Clarke E. Temporal trends in the management of metacarpal and phalangeal fractures in the 21st century: an analysis of Australian population-based data. ANZ J Surg 2022; 92:2655-2660. [PMID: 35785509 DOI: 10.1111/ans.17818] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fractures of the hand, specifically the metacarpals and phalanges, are a common injury. Whilst many of these fractures can be treated non-operatively, a number of advances have led to the increase in popularity of surgical intervention. The aim of this study was to assess and describe trends in management of phalangeal and metacarpal fractures in Australia over the last two decades. METHODS A review was conducted of the Medicare Benefits Scheme (MBS), specifically querying the item numbers pertaining to the management of metacarpal and phalanx fractures. Data was recorded as the incidence per 100 000 patients. RESULTS Overall, there was a statistically significant decrease in the incidence of closed reduction of metacarpal and phalanx fractures, with a converse statistically significant increase in open reduction internal fixation. CONCLUSION This study demonstrates that over the last 20 years, there has been a decrease in closed reduction of intra- and extra-articular phalangeal and metacarpal fractures, with a converse but smaller increase in open reduction and fixation. These trends are likely multi-factorial in aetiology, and should be monitored to guide resource allocation and health provision in the future.
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Affiliation(s)
- Brahman S Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, the University of Sydney
| | - Vincent V G An
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael J Symes
- Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - David J Graham
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Richard D Lawson
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Clarke
- Faculty of Biomechanics, University of Sydney, Sydney, New South Wales, Australia
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17
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Sivakumar BS, An VVG, Graham DJ, Ledgard J, Lawson RD, Furniss D. Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review. Hand (N Y) 2022; 17:595-601. [PMID: 32988227 PMCID: PMC9274898 DOI: 10.1177/1558944720928503] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.
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Affiliation(s)
- Brahman S. Sivakumar
- Royal North Shore Hospital, St Leonards, NSW, Australia,Brahman S. Sivakumar, Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
| | | | | | - James Ledgard
- Royal North Shore Hospital, St Leonards, NSW, Australia
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18
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Üstün GG, Kargalıoğlu F, Akduman B, Arslan R, Kara M, Gürsoy K, Koçer U. Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment. J Plast Reconstr Aesthet Surg 2021; 75:286-295. [PMID: 34275778 DOI: 10.1016/j.bjps.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/10/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery. PATIENTS/METHODS Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analyzed. RESULTS The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery. CONCLUSION Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions. LEVEL OF EVIDENCE Level 4, Case-control study.
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Affiliation(s)
- Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey.
| | - Ferhat Kargalıoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Burkay Akduman
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Ramazan Arslan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Koray Gürsoy
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Uğur Koçer
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
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19
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Poggetti A, Fagetti A, Lauri G, Cherubino M, Borelli PP, Pfanner S. Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up. J Hand Surg Eur Vol 2021; 46:466-470. [PMID: 33444072 DOI: 10.1177/1753193420980324] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment of extra-articular metacarpal and phalangeal fractures should be considered when there is instability or in patients with high demand. To overcome the issues related to the use of Kirschner wires, external fixators, and open reduction and internal fixation procedures, intramedullary headless screw fixation (IHSF) is an alternative technique to achieve primary fracture stability and early return to daily activities. We report the data of the Italian Multicentric Intra-Medullary Experience, which includes 173 cases of extra-articular unstable fractures (38 phalanges and 135 metacarpals) treated with the IHSF. After surgery, patients underwent early mobilization without splinting. The results confirm the reliability of IHSF in cases with non-articular involvement, showing a good recovery rate in terms of bone healing and range of motion.Level of evidence: IV.
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Affiliation(s)
- Andrea Poggetti
- AOU Careggi, Hand and Microsurgery Reconstruction Unit, Florence, Italy
| | | | - Giulio Lauri
- AOU Careggi, Hand and Microsurgery Reconstruction Unit, Florence, Italy
| | | | | | - Sandra Pfanner
- AOU Careggi, Hand and Microsurgery Reconstruction Unit, Florence, Italy
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20
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe treatment options for phalangeal fractures. 2. Choose an appropriate fracture management plan that optimizes patient goals and range of motion. 3. Describe closed and open reduction techniques of commonly encountered phalangeal fracture patterns. SUMMARY Phalangeal fractures are the second most common upper extremity fracture. Although many can be treated with splinting, operative intervention may be required for unstable fracture patterns and those involving the articular surface. Failure to appropriately treat these fractures can result in finger stiffness, loss in range of motion, and functional deficits. The type of fixation method can range from percutaneous pinning to open reduction and internal fixation. This article presents a series of cases to illustrate the appropriate management of phalangeal fractures using an evidence-based approach.
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21
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Tang JB, Landín L, Cavadas PC, Thione A, Chen J, Pons G, Masià J. Unique Techniques or Approaches in Microvascular and Microlymphatic Surgery. Clin Plast Surg 2021; 47:649-661. [PMID: 32892807 DOI: 10.1016/j.cps.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| | - Luis Landín
- Plastic & Reconstructive Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Pedro C Cavadas
- Reconstructive Surgery Unit, Clinica Cavadas, Paseo Facultades 1, bajo 8, Valencia 46021, Spain
| | - Alessandro Thione
- Reconstructive Surgery Unit, Clinica Cavadas, Paseo Facultades 1, bajo 8, Valencia 46021, Spain
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, Barcelona 08026, Spain
| | - Jaume Masià
- Department of Plastic Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, Barcelona 08026, Spain
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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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Mirza A, Mirza JB, Thomas TL. Premeasured Intramedullary Nails for the Treatment of Metacarpal Fractures: Novel Instrumentation and Technique. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:250-255. [PMID: 35415502 PMCID: PMC8991423 DOI: 10.1016/j.jhsg.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/26/2020] [Indexed: 11/24/2022] Open
Abstract
With nearly 36% of hand fractures occurring at the metacarpal, a variety of treatment interventions have been developed. Although many nondisplaced metacarpal fractures can be treated with conservative management, displaced, unstable, open, and extra-articular fractures require surgical attention. Compared with open reduction with plate fixation, closed reduction with intramedullary fixation has shown advantages of a simplified technique, minimal soft tissue dissection, and reduced tendon irritation and scar formation. The current study reports on the improved surgical technique associated with the use of novel instrumentation for the closed reduction and intramedullary fixation of extra-articular metacarpal fractures. The design and surgical technique of the premeasured Secure Intramedullary Nail improves fracture fixation, minimizing rotation and backing out, while reducing concerns for soft tissue irritation complications at the base of the metacarpal. Our reported case series suggests procedural efficiency, a low complication rate, and fast recovery for those with indicated extra-articular fractures.
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24
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Zhao W, Wang G, Chen B, Xiao J, Sun X, Wu T, Ren H, Li X. The value of ultrasound for detecting hand fractures: A meta-analysis. Medicine (Baltimore) 2019; 98:e17823. [PMID: 31689869 PMCID: PMC6946312 DOI: 10.1097/md.0000000000017823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUNDS Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as an alternative method of detecting hand fractures. In this study, we used meta-analysis to assess the diagnostic value of ultrasound for hand fractures. METHODS Web of Science, PubMed, Embase, and Cochrane Library databases were searched for relative citations up to June 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC), and summary receiver operating characteristic (SROC) curve were estimated. RESULTS Seven studies including 842 participants (845 examined hands) met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of ultrasound for detecting hand fractures were 91%, 96%, 20.66, and 0.09, respectively. The pooled DOR was 231.17, indicating a very powerful diagnostic ability of ultrasound. Meta-regression showed that there was no heterogeneity with respect to age, cut-off, the performer of the ultrasound, and the types of hand fractures. CONCLUSIONS Our results showed that ultrasound had an excellent diagnostic value for hand fractures. In clinic, we proposed using ultrasound as a first-line and radiation-free modality in detecting hand fractures, including phalanx and metacarpal fractures.
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Affiliation(s)
| | | | - Binjuan Chen
- Ultrasonic Department, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | | | | | - Tingting Wu
- Ultrasonic Department, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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25
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Lazarus P, Hidalgo Diaz JJ, Xaxier F, Gouzou S, Facca S, Liverneaux P. Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:425-433. [PMID: 31667582 DOI: 10.1007/s00590-019-02587-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS®, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.
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Affiliation(s)
- Priscille Lazarus
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Juan José Hidalgo Diaz
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Fred Xaxier
- Department of Surgery (Spine), Dalhousie University, QEII Health Sciences Centre - Halifax Infirmary, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - Stéphanie Gouzou
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France.
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Sterile Adhesive Tape as an Isolation Device in Phalangeal Fracture Fixation. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang X, Yu Y, Shao X, Dhawan V, Du W. A randomized comparison of bone-cement K-wire fixation vs. plate fixation of shaft fractures of proximal phalanges. PHYSICIAN SPORTSMED 2019; 47:189-198. [PMID: 30408421 DOI: 10.1080/00913847.2018.1546106] [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: 10/27/2022]
Abstract
BACKGROUND The objective of this study (ClinicalTrials.gov ID: NCT03031015) is to compare the treatments of hand proximal phalanx shaft fractures with external-fixation technique using the combination of K-wires and bone-cement vs. open reduction and internal fixation technique using a miniature plate-and-screw system. METHODS A total of 107 patients (134 cases) were randomly allocated to group A (67 cases in 56 patients) and B (64 cases in 51 patients). Fingers in group A were treated with bone-cement K-wire fixation, and fingers in group B were treated using a plate-and-screw system. RESULTS Follow-ups lasted 2 years. In group A, active range of motion of proximal interphalangeal joint reached 93% ± 6.7% of the opposite fingers. In group B, the data reached 86% ± 14.4% of the opposite fingers. Based on total active motion scoring system, we obtained 21 excellent and 46 good results in group A; and 9 excellent, 50 good, and 5 fair results in group B. There was a significant difference with regards to the function of the fingers (p < 0.05). CONCLUSIONS The bone-cement K-wire fixation may be another option for the treatment of shaft fractures of proximal phalanges. The minimally invasive technique allows early joint motion, resulting in minimal complications and good functional recovery.
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Affiliation(s)
- Xu Zhang
- a Department of Hand Surgery , Third Hospital of Hebei Medical University , Shijiazhuang , Hebei , China
| | - Yadong Yu
- a Department of Hand Surgery , Third Hospital of Hebei Medical University , Shijiazhuang , Hebei , China
| | - Xinzhong Shao
- a Department of Hand Surgery , Third Hospital of Hebei Medical University , Shijiazhuang , Hebei , China
| | - Vikas Dhawan
- b Dept. of Orthopedics and Sports Medicine , University of Kentucky , Lexington , KY , USA
| | - Wei Du
- a Department of Hand Surgery , Third Hospital of Hebei Medical University , Shijiazhuang , Hebei , China
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Zilliacus K, Ryhänen J, Waris E. Percutaneous, intramedullary technique for reduction of impacted intra-articular phalangeal fractures. J Hand Surg Eur Vol 2018; 43:560-561. [PMID: 29554844 DOI: 10.1177/1753193418764307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Kaj Zilliacus
- Department of Hand Surgery, Töölö Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Töölö Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, Töölö Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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De Silvestro A, Martini K, Becker A, Kim-Nguyen T, Guggenberger R, Calcagni M, Frauenfelder T. Postoperative imaging of orthopaedic hardware in the hand and wrist: is there an added value for tomosynthesis? Clin Radiol 2018; 73:214.e1-214.e9. [DOI: 10.1016/j.crad.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 01/08/2023]
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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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