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Kwan SA, Moncman TG, Sodha S, Jones C, Matzon JL, Rivlin M. Screw Position Following Percutaneous Versus Mini-Open Intramedullary Retrograde Screw Fixation of Metacarpal Fractures. Hand (N Y) 2024:15589447241241765. [PMID: 38567532 DOI: 10.1177/15589447241241765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Metacarpal fracture fixation using the retrograde intramedullary screw technique can be performed through two different approaches. The mini-open approach requires greater soft tissue dissection but allows for direct visualization of the metacarpal head compared with the percutaneous approach. Our aim was to determine which approach resulted in optimal screw position. METHODS Eighty-one consecutive patients that underwent intramedullary screw fixation for metacarpal fractures from 2016 to 2021 were identified. Patients were treated by 4 fellowship-trained orthopedic hand surgeons who employed the mini-open or percutaneous approach. Postoperative radiographs were reviewed for screw position. RESULTS A total of 81 patients (41 mini-open, 40 percutaneous) were included in this study. There were no significant differences between the two groups in age, sex, hand dominance, or affected digit. Postoperative screw position at first postoperative visit was not significantly different between the two groups on anteroposterior or lateral radiographs. CONCLUSION Postoperative screw position is not significantly different between the mini-open and percutaneous approaches for intramedullary screw fixation of metacarpal fractures. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Stephanie A Kwan
- Department of Orthopaedic Surgery, Jefferson Health, Stratford, NJ, USA
| | - Tara Gaston Moncman
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Samir Sodha
- Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Christopher Jones
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jonas L Matzon
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Rivlin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Kwan SA, Wang WL, Tulipan JE, Kachooei A, Beredjiklian PK, Rivlin M. Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study. J Wrist Surg 2024; 13:54-57. [PMID: 38264131 PMCID: PMC10803140 DOI: 10.1055/s-0042-1758705] [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: 06/08/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.
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Affiliation(s)
- Stephanie A. Kwan
- Department of Orthopaedic Surgery, Rowan University SOM, Stratford, New Jersey
| | - William L. Wang
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jacob E. Tulipan
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Amir Kachooei
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Bui GA, Huang JI. Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures. Hand Clin 2023; 39:475-488. [PMID: 37827601 DOI: 10.1016/j.hcl.2023.05.014] [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: 10/14/2023]
Abstract
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.
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Affiliation(s)
- Gabrielle Anne Bui
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 908 Jefferson Street, Ninth Floor, Seattle, WA 98104, USA
| | - Jerry I Huang
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way Northeast, Box 354740, Seattle, WA 98105, USA.
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Bhashyam AR, Mudgal C. Intramedullary Headless Screw Fixation for Metacarpal Fractures - Technical Tips. J Hand Surg Asian Pac Vol 2023; 28:144-148. [PMID: 36866824 DOI: 10.1142/s2424835523710017] [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: 03/04/2023]
Abstract
Metacarpal fractures are a common injury in the hand. When surgical intervention is indicated, there are multiple approaches and techniques of fixation. Intramedullary fixation has become an increasingly versatile method of fixation. The limited dissection needed for its insertion, rotational stability provided by the isthmic fit and lack of requisite hardware removal are improvements over conventional K-wire or plate fixation techniques. Multiple outcome studies have confirmed its safety and effectiveness. In this technical note, we provide some tips that can help surgeons considering intramedullary headless screw fixation of metacarpal fractures. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Abhiram R Bhashyam
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chaitanya Mudgal
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Hug U, Fiumedinisi F, Roos J, Pallaver A, Bodmer E, Liechti R. Torque load on biodegradable magnesium screws during intramedullary insertion into a metacarpal bone – a biomechanical study. HAND SURGERY & REHABILITATION 2022; 41:341-346. [DOI: 10.1016/j.hansur.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022]
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Intramedullary Screw Fixation Comprehensive Technique Guide for Metacarpal and Phalanx Fractures: Pearls and Pitfalls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3895. [PMID: 34712548 PMCID: PMC8547932 DOI: 10.1097/gox.0000000000003895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
Background: Phalangeal and metacarpal fractures are the second and third most common upper extremity fractures after distal radius fractures with varying methods of fixation techniques. Intramedullary screw fixation is an increasingly preferred method of fixation. Benefits include early range of motion, faster recovery, limited dissection, and reduced complications. Improper technique, which is readily avoidable, can lead to suboptimal results. Methods: A review of recent literature on current techniques aims to summarize the biomechanics of intramedullary screw fixation and outline appropriate technique of placing headless compression screws for metacarpal and phalangeal fractures. Results: We discuss through images and videos the indications, preoperative workup, and technical pearls and pitfalls to encourage surgeons to add this technique to their armamentarium and improve outcomes. Conclusions: intrameduallry screw fixation is a powerful option for metacarpal and phalanx fixation that allows rigid stability, enabling early return of function with excellent rates of union and total active motion. With knowledge of technical pearls presented in this article, common mistakes can be avoided to improve efficiency of screw placement and optimize patient outcomes.
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García-Medrano B, Honecker S, Facca S, Simón FP, Delgado PJ, Liverneaux P. Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:427-436. [PMID: 33999263 DOI: 10.1007/s00590-021-02977-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
The purpose of the present study was to determine clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw fixation for metacarpal neck and shaft fractures (group I) versus percutaneous antegrade and retrograde intramedullary double pinning linked by a connector (group II). We designed a retrospective comparative study, with the inclusion of two groups (20 patients each) of metacarpal unstable fractures. Both groups showed similar outcomes at the final follow-up, except for extension lag (significantly better in group II) and return to sport (significantly better in group I). Intramedullary screw fixation did not accelerate bone union and range of motion recovery in the early follow-up. In conclusion, limited-open retrograde intramedullary headless screw fixation and percutaneous connected antegrade and retrograde intramedullary double pinning are both reliable techniques of fixation for metacarpal neck and shaft fractures. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Belén García-Medrano
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain.
| | - Sophie Honecker
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.,UMR7357, ICube CNRS, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France
| | - Fernando Polo Simón
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain
| | - Pedro J Delgado
- Department of Hand Surgery and Microsurgery, HM Montepríncipe, Paseo Juan XXIII, n. 23, 2-6, 28040, Madrid, Spain
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.,UMR7357, ICube CNRS, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France
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