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Yu D, Guo L, Li C, Chen B. Comparison of mini-plate versus Kirschner wire internal fixation for fifth metacarpal basal fractures with carpometacarpal joint dislocation. Am J Transl Res 2024; 16:3129-3138. [PMID: 39114674 PMCID: PMC11301464 DOI: 10.62347/wwza3041] [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: 03/13/2024] [Accepted: 05/29/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To compare the outcome of mini-plate versus Kirschner wire (K-wire) internal fixation for treating fifth metacarpal basal fractures with carpometacarpal joint dislocation. METHOD A total of 46 patients with fifth metacarpal basal fractures combined with carpometacarpal joint dislocation were divided into two groups. The control group received K-wire fixation, while the observation group underwent mini-plate fixation. We assessed treatment effectiveness, surgical parameters, range of motion, serum stress markers, quality of life scores, and postoperative complication rates. A multivariable logistic regression analysis was performed to identify factors influencing postoperative joint function. RESULTS The observation group demonstrated a significantly higher excellent and good rate compared to the control group (P<0.05). Additionally, the observation group had a lower intraoperative bleeding volume, shorter incision lengths, and faster fracture healing times, all significant differences (all P<0.05). Postoperative assessments indicated that range of motion, quality of life scores, and superoxide dismutase levels were significantly improved in the observation group (P<0.05). Conversely, cortisol, angiotensin II, and norepinephrine levels, along with the incidence of postoperative complications, were lower in the observation group compared to the control group (all P<0.05). Logistic regression analysis identified the surgical method as an independent factor affecting postoperative metacarpal joint function (OR = 0.16, P = 0.003). CONCLUSION Mini-plate internal fixation is superior to K-wire fixation for the treatment of fifth metacarpal basal fractures with carpometacarpal joint dislocation. It promotes faster fracture healing, reduces serum stress markers, enhances joint mobility and quality of life, and decreases postoperative complications.
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Affiliation(s)
- Dadong Yu
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Lijun Guo
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Cheng Li
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Bin Chen
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
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Heifner JJ, Falgiano PA, Vegas AT, Chambers LR, Mercer DM. Intramedullary Nail Fixation for Metacarpal Fracture: A Case Report and Review of the Clinical and Biomechanical Evidence. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:466-470. [PMID: 39166185 PMCID: PMC11331152 DOI: 10.1016/j.jhsg.2024.02.012] [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: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 08/22/2024] Open
Abstract
We present two cases of complex metacarpal fractures treated with an intramedullary locking nail. This is an emerging fixation method that minimizes tissue insult, provides sufficient stability, and allows early mobilization. Locking nails accommodate the capture of fractured fragments in complex unstable patterns and provide longitudinal and rotational stability. The described intrafocal technique is intended to improve coaxial placement of the wire into the medullary canal.
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Affiliation(s)
| | | | - Austin T. Vegas
- Department of Orthopaedic Surgery, Larkin Hospital Miami, FL
| | | | - Deana M. Mercer
- Department of Orthopaedics, University of New Mexico, Albuquerque, NM
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3
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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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5
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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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George AR, Abbot H, McCarron L, Graham DJ, Sivakumar BS. Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures. J Hand Surg Am 2024:S0363-5023(23)00690-1. [PMID: 38310510 DOI: 10.1016/j.jhsa.2023.12.011] [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: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures. METHODS A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature. RESULTS Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort. CONCLUSION Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Adam R George
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Hagen Abbot
- Faculty of Medicine and Health, Sydney Medical School, 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; Griffith University School of Medicine and Dentistry, Southport, QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Brahman S Sivakumar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia; Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, 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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Hassan K, Blumenthal S, Jehle CC, Sobel AD. Intramedullary Fixation of Hand Fractures and Arthrodeses. J Hand Surg Am 2024; 49:42-49. [PMID: 37777934 DOI: 10.1016/j.jhsa.2023.08.011] [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: 10/09/2022] [Revised: 05/25/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the hand has gained increasing interest, specifically in the metacarpals and phalanges, corresponding with the development of improved cannulated headless screw technology. Along with the advantages of increased operative speed and less surgical dissection, which can promote rapid healing, many benefits exist, supporting their use despite some drawbacks. This article reviews the background and biomechanics of intramedullary fixation with a specific focus on cannulated headless screws, describes the application and techniques of intramedullary screw fixation in the hand, and details the associated outcomes and costs for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis.
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Affiliation(s)
- Kareem Hassan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Sarah Blumenthal
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Charles C Jehle
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
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8
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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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Leftley C, Nikkhah D, Southall C, Labib A, Moledina J. Expanding the applications of intramedullary cannulated screw fixation in the hand. J Plast Reconstr Aesthet Surg 2023; 80:48-55. [PMID: 36996502 DOI: 10.1016/j.bjps.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Intramedullary cannulated headless compression screw fixation (ICHCS) is gaining popularity for managing metacarpal and phalangeal fractures, but is still relatively new to the surgical landscape. We aim to further illustrate its utility and versatility by presenting the outcomes of such fractures treated with ICHCS at two tertiary plastic surgery centres. Primary objectives were to assess functional range of motion, patient-reported outcomes, and complication rates. MATERIALS AND METHODS All patients with metacarpal or phalangeal fractures treated with ICHCS (n = 49) between September 2018 and December 2020 were retrospectively reviewed. Outcomes were active ranges of motion (TAM), QuickDASH scores (obtained via telephone), and complication rates. Two-tailed Student's t-tests evaluated differences between centres. RESULTS TAMs were available for 59% (n = 34/58) of fractures; 70.7% were metacarpal and 29.3% were phalangeal. The mean cohort metacarpal TAMs and phalangeal TAMs were 237.7° and 234.5°, respectively. QuickDASH scores were available for 69% (n = 34/49) of patients. The mean cohort score for metacarpal fractures was 8.23, and 5.13 for phalangeal. Differences between the two centres were statistically significant (p < 0.05). Two complications occurred, giving an overall complication rate of 3.45%. CONCLUSION Our results corroborate previous reports on ICHCS, further demonstrating its versatility and capacity to provide excellent outcomes. More prospective, comparative studies are needed to fully determine the suitability of ICHCS.
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Affiliation(s)
- Chloe Leftley
- University College London Medical School, Gower Street, London WC1E 6BT, United Kingdom
| | - Dariush Nikkhah
- University College London Medical School, Gower Street, London WC1E 6BT, United Kingdom; Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, United Kingdom; University College London Division of Surgery and Interventional Science, United Kingdom.
| | - Clea Southall
- Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, United Kingdom
| | - Amir Labib
- St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Jamil Moledina
- St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
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Internal Fixation of Finger Fractures: Field Sterility for Surgery and Earlier Removal of K-Wires Are Safe. Hand Clin 2022; 38:299-303. [PMID: 35985753 DOI: 10.1016/j.hcl.2022.02.002] [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: 02/02/2023]
Abstract
Field sterility for K-wire insertion outside the main operating room is much cheaper and greener (ie, there is less waste). It permits increased access to more affordable surgery because unnecessary sedation and full sterility are eliminated. Early pain-guided protected movement of K-wired finger fractures at 3 to 5 days leads to less stiffness. It will not result in loss of reduction or infection around K-wires if patients avoid "pain" (ie, do not perform movements that hurt). Early protected movement and early removal of K-wires at 2 to 4 weeks contribute to less stiffness after operative hand/finger fracture reduction and stabilization.
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