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Veeramani A, Meulendijks MZ, Szapary H, Moura SP, Gomez-Eslava B, Hoftiezer YA, Chen NC, Eberlin KR. Phalangeal fractures: A retrospective comparison of open reduction and internal fixation vs. closed reduction and percutaneous pinning. J Hand Microsurg 2024; 16:100124. [PMID: 39234367 PMCID: PMC11369723 DOI: 10.1016/j.jham.2024.100124] [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: 03/10/2024] [Revised: 06/23/2024] [Accepted: 06/30/2024] [Indexed: 09/06/2024] Open
Abstract
The treatment of phalangeal fractures is guided by fracture characteristics, patient factors and surgeon judgment. This study retrospectively compares characteristics of phalangeal fractures treated with closed reduction percutaneous pinning (CRPP) with those of fractures treated with open reduction internal fixation (ORIF) to identify risk factors associated with reoperation. A total of 901 phalangeal fractures were included and treated operatively by either CRPP (748 fractures, 83 %) or ORIF (153 fractures, 17 %). Demographics, surgical management, and complication data were collected. Statistical analyses were performed to stratify risk associations and identify potential predictors of reoperation. With multivariate analysis and bootstrapped LASSO regression, fractures addressed by means of ORIF (vs. CRPP), work-related fractures, and open fractures were found to be independently associated with reoperation. These findings can be used to guide patient selection, surgical planning and timing of fracture repair. Level of evidence Level III, Therapeutic.
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Affiliation(s)
- Anamika Veeramani
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Mara Z. Meulendijks
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA
| | - Hannah Szapary
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Steven P. Moura
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA
- Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
| | - Barbara Gomez-Eslava
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Yannick A.J. Hoftiezer
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud Institute of Health Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Neal C. Chen
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kyle R. Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Mortada H, AlNojaidi TF, Bhatt G, Bafail A, Koorapaty P, Alsanad LA, Almehaid F, Alrobaiea S, Alalola R, Kattan AE. Evaluating Kirschner wire fixation versus titanium plating and screws for unstable phalangeal fractures: A systematic review and meta-analysis of postoperative outcomes. J Hand Microsurg 2024; 16:100055. [PMID: 39035864 PMCID: PMC11257138 DOI: 10.1016/j.jham.2024.100055] [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: 07/23/2024] Open
Abstract
Background Unstable phalangeal fractures represent a clinical challenge in hand surgery. The choice of fixation method, whether Kirschner wire (K-wire) fixation or titanium plating with screws, often depends on surgeon preference due to the lack of comprehensive comparative data. This article aimed to compare the postoperative outcomes of K-wire fixation versus titanium plating and screws in the treatment of unstable phalangeal fractures. Methods This review was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. A systematic review and meta-analysis of the existing literature was done encompassing PUBMED, EMBASE, Google Scholar, and Cochrane library using the keywords: "K wire/ Kirschner wire", "titanium plate/ screws", "Miniplate/ screws", and "Unstable phalan∗ fracture/ hand fracture". Results After screening 2374 articles, 6 final studies with a total of 414 patients were included. Operative time was significantly shorter with K-wire fixation compared to plating, by a mean difference of -27.03 min [95% CI -43.80, -10.26] (p = 0.02). Time to radiographic union averaged 7.43 weeks with K-wires versus 8.21 weeks with titanium plates. No statistically significant differences emerged between groups for overall complications (p = 0.69), infection (p = 0.47), malunion (p = 0.36), stiffness (p = 0.11), or need for reoperation (p = 0.10). Conclusion K-wire fixation demonstrated shorter mean operating time and faster radiographic union versus plating for unstable phalangeal fractures. These findings can guide surgical decisions and emphasize the need for individualized treatment based on fracture type and patient factors.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Taif Fawaz AlNojaidi
- Department of Plastic and Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gaurang Bhatt
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Anas Bafail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Piyush Koorapaty
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | | | - Faisal Almehaid
- Department of Plastic and Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saad Alrobaiea
- Department of Plastic Surgery and Burn Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Rayan Alalola
- Department of Plastic Surgery, Security Forces hospital, Riyadh, Saudi Arabia
| | - Abdullah E. Kattan
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Raducha JE, Hammert WC. Metacarpal and Phalangeal Malunions-Is It all About the Rotation? Hand Clin 2024; 40:141-149. [PMID: 37979986 DOI: 10.1016/j.hcl.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger alignment including malrotation and severe angulation as well as intra-articular deformities can lead to functional deficits which may benefit from operative intervention. There are numerous surgical options to correct malunions and the correct choice varies based on the injury pattern, concurrent injuries/complications, and surgeon's preference. While these surgeries can be technically demanding, successful treatment can lead to good results with satisfactory deformity correction and patient function.
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Affiliation(s)
- Jeremy E Raducha
- Department of Orthopaedic Surgery, Hand, Upper Extremity and Microsurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Warren C Hammert
- Department of Orthopaedic Surgery, Hand, Upper Extremity and Microsurgery, Duke University Medical Center, Durham, NC 27710, USA.
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Lee BJ, Lee CH, Lee YH, Woo S. Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2911-2920. [PMID: 36906666 DOI: 10.1007/s00590-023-03503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures. METHODS This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients. RESULTS Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6 weeks as compared with that noted in the unaffected side. The gas cavity upon H2 gas formation was first observed approximately 2 weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery. CONCLUSION Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.
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Affiliation(s)
- Bong-Ju Lee
- Department of Orthopedics, Daejeon Sun Hospital, 29 Mok-dong, Jung-gu, Daejeon, 34811, South Korea
| | - Chul-Hyung Lee
- Department of Orthopedics, Daejeon Sun Hospital, 29 Mok-dong, Jung-gu, Daejeon, 34811, South Korea.
| | - Young-Ho Lee
- Department of Orthopedics, Daejeon Sun Hospital, 29 Mok-dong, Jung-gu, Daejeon, 34811, South Korea
| | - Seungha Woo
- Department of Orthopedics, Daejeon Sun Hospital, 29 Mok-dong, Jung-gu, Daejeon, 34811, South Korea
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Harbrecht A, Hackl M, Leschinger T, Uschok S, Müller L, Wegmann K. Metacarpal fractures - A method to simulate life-like fractures in human cadaveric specimens for surgical education. HAND SURGERY & REHABILITATION 2022; 41:214-219. [DOI: 10.1016/j.hansur.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Pickens AC, Paterno AV, Draeger RW. Design Parameters of Hand Surgery Screws: Measurement Discrepancies and Clinical Implications. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:348-351. [PMID: 35415582 PMCID: PMC8991776 DOI: 10.1016/j.jhsg.2021.06.010] [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: 02/18/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The use of self-tapping cortical screws is indicated in patients with metacarpal and phalangeal fractures requiring formal stabilization. The aim of this study was to systematically compare and evaluate the design parameters of 4 commercially available self-tapping screw systems. Methods We measured various design parameters of self-tapping cortical screws of different lengths from several manufactures using scanning electron microscopy. Screws were obtained in 8, 12, 16, and 20 mm lengths. The measured parameters included screw length, head height, pitch, outer diameter, inner diameter, terminal thread diameter, terminal thread-to-tip distance, thread-to-tip distance of 1 full revolution, and crest width. Data were assessed statistically using 1- and 2-way analysis of variance (ANOVA) tests, and the significance level was set at a P value < .05. Results There was variability in advertised screw lengths compared with measured screw lengths with 2 manufacturers. There was a statistically significant difference between the thread-to-tip distance and head height between screws while controlling for diameter. Conclusions Screw sizes and dimensions are critical in order to avoid complications such as prominent hardware and postoperative stiffness. Knowledge of the design parameters presented for each of the different manufacturers may prove useful to hand surgeons when selecting screws for fixation of metacarpal and phalangeal fractures. Clinical relevance Specific design characteristics of commonly used screws in hand surgery vary slightly by manufacturer and may have clinically relevant implications in fixation of metacarpal and phalangeal fractures.
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Affiliation(s)
- Andrew C. Pickens
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Anthony V. Paterno
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Reid W. Draeger
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC
- Corresponding author: Reid W. Draeger, MD, Department of Orthopaedics, University of North Carolina School of Medicine, 3102 Bioinformatics Building, CB #7055, Chapel Hill, NC 27516.
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Köse A, Engin MÇ, Topal M, Köse M, Şencan A. Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.468120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Köse A, Topal M, Engin MÇ, Şencan A, Dinçer R, Baran T. Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:597-604. [PMID: 30426217 DOI: 10.1007/s00590-018-2342-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to present the radiological and clinical results of Kirschner-wire (K-wire) fixation and low-profile plate-screw fixation applied to unstable proximal phalangeal fractures without extension to the joint. METHODS Clinical and radiological data of 22 patients who underwent fixation with open reduction and low-profile 1.5-mm titanium mini plate and unlocked screws and 18 patients who underwent fixation with K-wire due to closed, unstable extra-articular proximal phalangeal fractures were retrospectively examined. All evaluation and statistical analyses were based on sixth postoperative month evaluation parameters. Active and passive metacarpophalangeal joint and interphalangeal joint range of motions, total joint range of motion, measurement of grip strength for fractured and healthy hands, visual analog scoring, disabilities of the arm, shoulder, and hand scores, measurement of distance between the pulpa and palmar curve in the operated finger, Belsky score, reoperation, and complications were evaluated. RESULTS Radiological union was achieved in all patients in a mean duration of 4.2 (3-6) weeks. When the functional results of the patients were evaluated, the mean active metacarpophalangeal joint flexion was 87.3° (75°-90°), mean proximal interphalangeal joint flexion was 94.3° (65°-100°), mean distal interphalangeal joint flexion was 77.6° (75°-80°), and mean total range of motion was 259° (210°-270°). The grip strength of the fractured hand was 52.7 (40-58) kgW, whereas that of the healthy hand was 54.4 (42-60) kgW. The mean value of visual analog score was 0.8 (0-2), mean score for disabilities of the arm, shoulder, and hand was 7 (2-27), and mean distance between the finger pulpa and finger curve was 3 (0-8) mm. CONCLUSION Plate-screw osteosynthesis in the extra-articular, unstable fractures of the proximal phalanx, which is "small" compared with the body but has a "major function" for the hand and upper extremity, allows for rigid fixation, short immobilization, and early motion in spiral/oblique-fragmented fractures. K-wire fixation, an alternative treatment modality, applied to selected fracture patterns with appropriate indications can achieve good-excellent results radiologically and functionally.
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Affiliation(s)
- Ahmet Köse
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Murat Topal
- Department of Orthopedics and Traumatology, Kastamonu University, Kastamonu, Turkey
| | | | - Ayşe Şencan
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Health Sciences University, İstanbul, Turkey
| | - Recep Dinçer
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Tuncay Baran
- Department of Orthopedics and Traumatology, Gölcük State Hospital, Kocaeli, Turkey
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Yalizis MA, Ek ETH, Anderson H, Couzens G, Hoy GA. Early unprotected return to contact sport after metacarpal fixation in professional athletes. Bone Joint J 2017; 99-B:1343-1347. [PMID: 28963156 DOI: 10.1302/0301-620x.99b10.bjj-2016-0686.r3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 05/28/2017] [Indexed: 11/05/2022]
Abstract
AIMS To determine whether an early return to sport in professional Australian Rules Football players after fixation of a non-thumb metacarpal fracture was safe and effective. PATIENTS AND METHODS A total of 16 patients with a mean age of 25 years (19 to 30) identified as having a non-thumb metacarpal fracture underwent open reduction and internal plate and screw fixation. We compared the players' professional performance statistics before and after the injury to determine whether there was any deterioration in their post-operative performance. RESULTS Of the 16, 12 sustained their fracture during the season: their mean time to return to unrestricted professional play was two weeks (1 to 5). All except two of the 48 player performance variables showed no reduction in performance post-operatively. CONCLUSION Our data suggest that professional athletes who sustained a non-thumb metacarpal fracture can safely return to professional play without restriction two weeks after internal fixation. Cite this article: Bone Joint J 2017;99-B:1343-7.
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Affiliation(s)
- M A Yalizis
- Melbourne Orthopaedic Group and Department of Upper Limb Surgery, 33 The Avenue, Windsor VIC 3181, Australia
| | - E T H Ek
- Melbourne Orthopaedic Group and Department of Upper Limb Surgery, 133 The Avenue, Windsor VIC 3181, Australia and Department of Surgery, Monash University, Wellington Rd, Clayton VIC 3800, Australia
| | - H Anderson
- Melbourne Orthopaedic Group and Department of Upper Limb Surgery, 33 The Avenue, Windsor VIC 3181, Australia
| | - G Couzens
- Brisbane Hand and Upper Limb Clinic, 259 Wickham Terrace, Spring Hill QLD 4000, Australia
| | - G A Hoy
- Melbourne Orthopaedic Group and Department of Upper Limb Surgery, 133 The Avenue, Windsor VIC 3181, Australia and Department of Surgery, Monash University, Wellington Rd, Clayton VIC 3800, Australia
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Singla A, Kalsi G, Masih N, Gupta T, Sharma M. Morphological and topographical anatomy of nutrient foramens in human metacarpals and their surgical importance. Surg Radiol Anat 2017; 39:1227-1233. [PMID: 28455539 DOI: 10.1007/s00276-017-1860-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/20/2017] [Indexed: 11/28/2022]
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Brooks A, Hammer E. Acute Upper Extremity Injuries in Young Athletes. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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13
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Abstract
The anatomy of the hand is complex, which allows for the dexterity, strength, and adaptability of the most functional aspect of the musculoskeletal system. The evaluation and management of injuries to this area can be time consuming and pose a significant medicolegal risk to the emergency physician. Improperly diagnosed and managed injuries can lead to chronic pain, inability to perform activities of daily living, and even seemingly minor injuries can lead to missed work causing a significant cost to the individual and society. The purpose of this article is to review injuries to the hand and wrist and discuss diagnostic studies and treatment plans that the emergency physician can use to treat patients effectively and minimize their exposure to risk.
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Szwebel JD, Ehlinger V, Pinsolle V, Bruneteau P, Pélissier P, Salmi LR. Reliability of a classification of fractures of the hand based on the AO comprehensive classification system. J Hand Surg Eur Vol 2010; 35:392-5. [PMID: 20100711 DOI: 10.1177/1753193409355256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The AO/ASIF Comprehensive Classification of Fractures is a logical system to describe and compare long-bone fractures. We adapted this classification to the hand to classify fractures of the metacarpals and phalanges. The alphanumeric sequence codes the bone involved, the bone segment, and the fracture type. To assess the reliability of this classification, one hundred radiographs of hand fractures were classified by nine observers in four sessions. Using Cohen's kappa coefficient, overall inter-observer agreement was 0.93 for bone identification, 0.80 for bone segment, and 0.44 for fracture type. Corresponding intra-observer agreement was 0.94, 0.92 and 0.62 respectively.
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Affiliation(s)
- J-D Szwebel
- CHU de Bordeaux, Service de Chirurgie Plastique et Chirurgie de la Main, Bordeaux, France.
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Yong FC, Tan SH, Tow BPB, Teoh LC. Trapezoid rotational bone graft osteotomy for metacarpal and phalangeal fracture malunion. J Hand Surg Eur Vol 2007; 32:282-8. [PMID: 17321650 DOI: 10.1016/j.jhsb.2007.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 12/30/2006] [Accepted: 01/08/2007] [Indexed: 02/03/2023]
Abstract
Metacarpal and phalangeal fracture malunions with significant angulation deformity are associated with bone shortening, prominence of the metacarpal head in the palm or pseudoclaw deformity and may be symptomatic. If so, they may need corrective osteotomy procedures. Conventional methods of closing, or opening, wedge osteotomy do not restore the length of the bone exactly. Simultaneous correction of the angular deformity and restoration of bone length can be addressed by a trapezoid rotational bone graft osteotomy. A double osteotomy is done and the segment of bone is rotated and re-inserted as a bone graft. This was done successfully in four metacarpal and two phalangeal fracture malunions with angulation deformities.
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Affiliation(s)
- F C Yong
- Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore.
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16
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Abstract
Fractures of the bones of the hand are among the commonest fractures in humans, but their management varies widely in the different regions of the world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Developing countries are more likely to apply less expensive methods of managing hand fractures. The treatment of these injuries will fall somewhere along a continuum that parallels the historical development of hand fracture management. This paper will review the history of phalangeal and metacarpal fracture management to infer global differences in the treatment of hand fractures. An overview of how different health care systems are likely to manage these injuries will assist health care providers in choosing the most appropriate treatment method.
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Affiliation(s)
- Michael L Bernstein
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, USA
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17
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Abstract
Patients expect physicians to predict the future. Recognizing injuries that behave badly improves care and modulates expectations. Your antennae should deploy when you are presented with a simple fracture that isn't.
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Affiliation(s)
- Mark E Baratz
- Division of Upper Extremity Surgery, Department of Orthopedics, Allegheny General Hospital, 1307 Federal Street, Pittsburgh, PA 15212, USA.
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18
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Abstract
Percutaneous K-wire fixation is still a useful technique for closed oblique phalangeal and meta-carpal fractures when an adequate closed reduction can be achieved. Lag screw fixation may be the best choice for open fixation of long oblique phalangeal and metacarpal fractures. For short oblique fractures, plating or tension band wiring is recommended. Plating provide rigid fixation to allow early mobilization; however, one may encounter frequent complications such as extensor lag, stiffness, or joint contracture when plating technique is used in phalangeal fractures. Tension band wiring technique at the phalangeal location may reduce such complications. Overall, successful outcomes of treating phalangeal and metacarpal fractures require a clear appreciation of fracture anatomy and pattern. It is mandatory for the treating surgeon to be familiar with all the treatment techniques discussed in order to tailor a specific technique for a particular injury and patient type.
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Affiliation(s)
- Kenji Kawamura
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340, USA
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Abstract
Injuries of the fingers and thumb in the athlete are common. Mallet finger, jersey finger, boutonniere deformity, Bennett and Rolando fractures, and gamekeeper's thumb are just a few of the injuries that can occur in athletes. A thorough understanding of the mechanism of injury, osseous and soft tissue abnormalities, imaging features, and treatment is important in the care of athletes. Prompt and accurate diagnosis is important and may help minimize outcomes of malunion, posttraumatic arthritis, and debility.
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Affiliation(s)
- Jeffrey J Peterson
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Harness NG, Chen A, Jupiter JB. Extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx. J Hand Surg Am 2005; 30:566-72. [PMID: 15925169 DOI: 10.1016/j.jhsa.2004.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 12/21/2004] [Accepted: 12/21/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate an extra-articular osteotomy rather than an intra-articular osteotomy in the treatment of malunited unicondylar fractures of the proximal phalanx. METHODS An extra-articular osteotomy was used to correct the deformity resulting from a malunion of a unicondylar fracture of the proximal phalanx in 5 patients. A closing wedge osteotomy that was stabilized with tension band fixation accomplished realignment of the joint. Each patient was evaluated at a minimum of 1 year after surgery for radiographic healing, correction of angulation, digital motion, postoperative complications, current level of pain with motion, and overall satisfaction with the procedure. RESULTS All of the osteotomies healed by 10 to 12 weeks after surgery with an average angular correction from 25 degrees to 1 degrees . The average proximal interphalangeal joint motion improved to 86 degrees from the preoperative average of 40 degrees , whereas the average total digital motion improved from 154 degrees before surgery to 204 degrees at follow-up evaluation. CONCLUSIONS This method of extra-articular osteotomy for malunited unicondylar fractures of the proximal phalanx is highly reproducible, avoids the risks of intra-articular surgery, and leads to a predictable outcome.
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Affiliation(s)
- Neil G Harness
- Harvard Medical School, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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Hardy MA. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts. J Orthop Sports Phys Ther 2004; 34:781-99. [PMID: 15643733 DOI: 10.2519/jospt.2004.34.12.781] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed- and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closed- and open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.
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Affiliation(s)
- Maureen A Hardy
- Hand Management Center, St Dominic Jackson Memorial Hospital, 969 Lakeland Dr, Jackson, MS 39216, USA.
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Affiliation(s)
- John J Walsh
- Section of Hand Surgery, Department of Orthopaedics, the University of South Carolina School of Medicine, Columbia, SC, USA
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Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32:262-73. [PMID: 14754754 DOI: 10.1177/0363546503261422] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome. The main focus of this section is the discussion of traumatic injuries to the hand in the athlete. Included is a discussion and review of fractures of the phalanges and metacarpals, common proximal interphalangeal joint injuries, and thumb carpal metacarpal and metacarpophalangeal joint injuries. Emphasis is placed on more common injuries seen regarding diagnosis, indications for non-operative versus operative treatment, and time to return to athletic competition.
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Schaffer TC. Disorders of the Upper Extremity. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dubert T, Valenti P, Dinh A, Osman N. [The VB system: a new modular osteosynthesis material involving both screws and wires]. CHIRURGIE DE LA MAIN 2002; 21:23-7. [PMID: 11885383 DOI: 10.1016/s1297-3203(01)00083-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
VB is an osteosynthesis system for the stabilisation of small fragments, which combines the benefits of both wires and screws. It is a modular system comprising a threaded pin and a ring. The threaded pin is first positioned. Then a ring is grasped and opened by the progressive angulation of a screwdriver. Still anchored on the screwdriver, the ring slides easily on the pin. It is clamped on the pin by simply removing the screwdriver and the pin is then cut. This modular system includes 1.8 and 1.1 mm pins and different types of rings (threaded or non threaded, with or without collars). The system is easy to handle and can be introduced using an open or percutaneous technique, allowing compression or distraction. Our preliminary series, performed in accordance with National clinical trial protocol (Huriet) consisted of 50 cases in 24 patients (five women and 19 men) with an average age of 48 years, and a follow-up of more than six months. Fourteen cases of fractures (28 implants) were treated as emergencies (two radial heads, one capitellum, one trochlea of the humerus, seven distal radius fractures, one trapezium, two metacarpals) and 12 cases (22 implants) were elective cases: arthrodesis (one trapezo-metacarpal, one intermetacarpal, two interphalangeal, two carpal), non-union (six scaphoids, one phalangeal) and one phalangeal malunion. Hardware removal was performed in 16 cases. No implant failure has been detected. One case, a DIP arthrodesis, had a suspicion of sepsis which led to the removal of the implants at six weeks. The results of this study have convinced us of the merits of the system, which combines the advantages of both wires and screws. The system allows the user to perform either distraction or compression, and to adjust the force by hand. Compared to the fixed amount of compression produced by lag screws, this feature seems to be a real step forward.
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Affiliation(s)
- T Dubert
- Clinique La Francilienne, 16, avenue de l'Hôtel de Ville, 77340, Pontault-Combault, France.
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