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George AR, Dragan Z, Abbot H, Handford C, Graham DJ, Sivakumar B. Metacarpal Fracture Fixation with Intramedullary Screws. J Hand Surg Asian Pac Vol 2024; 29:217-224. [PMID: 38726490 DOI: 10.1142/s2424835524500231] [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: 06/01/2024]
Abstract
Background: Intramedullary screws (IMS) have become a viable option for metacarpal fracture fixation. To further appraise their utility, this study assessed clinical and patient-reported short- and medium-term outcomes of IMS fixation for extra-articular metacarpal fractures. Methods: A retrospective cohort study was performed in a series of 32 patients (with a total of 37 fractures) who underwent metacarpal fracture fixation over a 42-month period between January 2020 and July 2023. Results: Mean time for return to work was 39.8 days; mean time for return to full function was 88.4 days; total active motion was 250.7° (range: 204.9-270.9); Quick Disabilities of the Arm, Shoulder and Hand score was 2.3 (range: 0-22.7); mean visual analogue pain score was 0.9 out of 10 (range: 0-6) and a single complication was observed. Conclusions: The use of IMS in metacarpal fracture fixation is a practicable surgical option. IMS fixations yields a satisfactory duration for return to function, good postoperative range of movement, modest pain scores and low rates of complications. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Adam R George
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Zac Dragan
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Hagen Abbot
- Faculty of Medicine and Health, The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Cameron Handford
- Department of Orthopaedic Surgery, St George Hospital, Gray St Kogarah, NSW, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - Brahman Sivakumar
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
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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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Sivakumar B, Graham DJ, Clarke E. Dorsal Plating, Lateral Plating, and Intramedullary Screw Fixation of Extra-Articular Proximal Phalangeal Fractures: A Cadaveric Biomechanical Comparison. J Hand Surg Am 2024; 49:247-252. [PMID: 38206273 DOI: 10.1016/j.jhsa.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To provide a biomechanical comparison of dorsal plating, lateral plating and intramedullary screw [IMS] fixation for extra-articular proximal phalangeal fractures. METHODS Midshaft osteotomies were performed on 36 cadaveric proximal phalanges. The phalanges were fixed by dorsal plating, lateral plating or IMS fixation, and subjected to a four-point bending force. Force was applied to achieve displacement of 1 mm/s, until construct failure or to a maximum of 10 mm of displacement. Clinical failure was defined as 2 mm of displacement, and force required to result in 1 mm and 2 mm of displacement was recorded, as was mode of failure. RESULTS Dorsal plating [127.5 N ± 52.6; 46.51-229.17] and lateral plating [77.1 N ± 25.1; 48.3-113.8] required significantly greater force to achieve 1 mm of displacement when compared to IMS [41.2 N ± 12.4; 20.6-62.3]. Dorsal plating [339.2 N ± 91.8; 158.5-538.6] required significantly greater force than lateral plating [154.5 N ± 33.8; 99.0 -204.4] and intramedullary screw fixation [110.0 ± 38.6; 51.1-189.3] to result in 2 mm of displacement. Lateral and dorsal plating constructs failed through plate bending, screw cut-out or plate failure, whilst IMS failed via implant deformity. All three constructs required greater force to result in even 1 mm of displacement than what is likely subjected through rehabilitation via active motion. CONCLUSIONS Lateral plating and IMS fixation offer sufficient stiffness to withstand the likely forces subjected via early active motion without displacement. CLINICAL RELEVANCE Dorsal plating required significantly greater force than lateral plating and intramedullary screw fixation to achieve 1 mm of displacement when used in extra-articular proximal phalangeal fractures in an in vitro setting. However, all three modalities confer enough stability to likely withstand the forces associated with active range of motion.
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Affiliation(s)
- Brahman Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; Department of Surgery, Faculty of Medicine, the University of Sydney, Camperdown, NSW, 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, Northern Beaches Hospital, Frenchs Forrest, NSW, Australia; Department of Medicine, University of Queensland, Herston, QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia.
| | - Elizabeth Clarke
- Murray Maxwell Biomechanics Laboratory, Kolling Institute, University of Sydney, Camperdown, NSW Australia
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