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Singh R, Sharma PK, Verma V, Kamboj V, Shoeran A, Sharma J. Functional and Radiological Outcomes of Miniature Plate Osteosynthesis in Metacarpal and Phalangeal Fractures of Hand: A Prospective Study. Cureus 2024; 16:e58759. [PMID: 38779225 PMCID: PMC11111098 DOI: 10.7759/cureus.58759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. MATERIAL AND METHODS A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. RESULT All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. CONCLUSIONS Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.
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Affiliation(s)
- Raj Singh
- Orthopedics and Trauma, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Pankaj Kumar Sharma
- Orthopedics, All India Institute of Medical Sciences, Bathinda, Bathinda, IND
| | - Vinit Verma
- Orthopedics and Trauma, Holy Heart Multispecialty Hospital, Rohtak, IND
| | - Vinod Kamboj
- Orthopedics and Traumatology, General Hospital Ambala, Ambala, IND
| | - Ajay Shoeran
- Orthopedics, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Jyoti Sharma
- Anesthesiology, All India Institute of Medical Sciences, Bathinda, Bathinda, IND
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Wallace DR, Shiver AL, Pulliam SK, Byrd BM, McGee-Lawrence ME, Snoddy MC. Intramedullary Threaded Nail Fixation Versus Plate and Screw Construct in Metacarpal Neck Fractures: A Biomechanical Study. J Am Acad Orthop Surg 2023; 31:e516-e522. [PMID: 37071886 PMCID: PMC10198952 DOI: 10.5435/jaaos-d-22-00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Indicated surgical management of metacarpal neck fractures varies with techniques, including Kirschner wire fixation, plate fixation, intramedullary fixation, and headless compression screw fixation, without demonstrated superiority. This study compares intramedullary threaded nail (ITN) fixation with a locking plate construct. METHODS Index through small finger metacarpals were harvested from 10 embalmed cadavers. After application of appropriate exclusion criteria, remaining metacarpals underwent neck fracture creation by a three-point load to failure. Eight samples were randomly allocated to fixation with ITN fixation, and six were stabilized with a 2.3-mm seven-hole locking plate. Samples were then subjected to a second round of biomechanical testing using the same apparatus. Ultimate load between the intact tissue and the subsequently stabilized fracture was analyzed with a paired Student t -test. Percentage change in ultimate load in the intact tissue and stabilized tissue was calculated, and the magnitude of relative difference between the two groups was analyzed using unpaired Student t -tests. Statistical difference was defined by a P value of < 0.05. RESULTS Both groups demonstrated the ability to handle a biomechanical load; however, both were significantly weaker than the intact tissue (paired Student t -test p ITN-fixed versus p ITN-intact = 0.006; p plate-fixed versus p plate-intact = 0.002). ITN samples demonstrated a higher load to failure (unpaired Student t -test p ITN-fixed versus p plate-fixed = 0.039). CONCLUSION ITN provides a biomechanically stronger fixation constructed for vertically oriented metacarpal neck fractures compared with locking plate fixation. Both ITN and locking plate constructs provide stabilization capable of tolerating a biomechanical load; however, both fixation modalities are weaker than the native tissue.
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Affiliation(s)
- Doyle R Wallace
- From Medical College of Georgia at Augusta University, Augusta, GA
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Hong DY, Berube ER, Strauch RJ. Ring finger metacarpal fracture iatrogenic rotation using an ulnar gutter splint: A cadaveric study. J Hand Ther 2022; 35:80-85. [PMID: 33279361 DOI: 10.1016/j.jht.2020.10.018] [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: 05/06/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cohort cadaveric study. INTRODUCTION Ring finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic "molding", resulting in a crossover deformity of the ring finger over the small finger. PURPOSE OF THE STUDY The goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. METHODS Transverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. RESULTS There was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). CONCLUSIONS Application of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.
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Affiliation(s)
- Daniel Y Hong
- Columbia University Medical Center, New York City, NY, USA.
| | - Emma R Berube
- Columbia University Medical Center, New York City, NY, USA
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Grisdela PT, Liu DS, Dyer GSM, Earp BE, Blazar P, Zhang D. Factors Associated With Implant Removal Following Plate-and-Screw Fixation of Isolated Metacarpal Fractures. J Hand Surg Am 2022:S0363-5023(22)00067-3. [PMID: 35305847 DOI: 10.1016/j.jhsa.2022.01.026] [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: 05/18/2021] [Revised: 12/09/2021] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The incidence of and associated risk factors for implant removal following the plate-and-screw fixation of metacarpal shaft fractures have not been well described. The primary objective of our study was to identify implant-related radiographic parameters associated with implant removal in patients treated with the plate-and-screw fixation of isolated, displaced metacarpal fractures at 2 years of follow-up. The secondary objective of our study was to identify patient-related factors associated with implant removal. METHODS A retrospective study of all patients who underwent open treatment of a metacarpal fracture with a plate-and-screw construct from January 1, 2000, to April 30, 2019, at 2 level-1 trauma centers was conducted. After the application of exclusion criteria, we identified 138 patients with a single isolated metacarpal fracture of a nonthumb digit treated with open reduction and internal fixation using a plate-and-screw construct. Our study endpoint was the removal of the plate-and-screw construct or a minimum of 2 years of follow-up without the removal of the hardware. Twenty-three patients achieved our study endpoint as determined using their electronic medical records, and 58 additional patients were reached via telephone to confirm their implant removal status. A bivariate analysis was used to screen for factors associated with implant removal, and variables significant in the bivariate screen were included in a multivariable stepwise logistic regression model. RESULTS Twenty-three out of 81 patients (28%) in our final cohort underwent implant removal by the final follow-up visit. In the logistic regression analysis, the distance between the plate and metacarpophalangeal joint, the distance between the plate and carpometacarpal joint, and active smoking were independently associated with implant removal. CONCLUSIONS The proximity of metacarpal plates to adjacent joints is associated with subsequent implant removal. Patients may be counseled about the higher risk of implant removal when periarticular metacarpal plating is performed. TYPE OF STUDY/LEVEL OF EVIDENCE Prognosis IV.
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Affiliation(s)
- Phillip T Grisdela
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - David S Liu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Retrouvey H, Jakubowski J, Al-Taha M, Steve A, Augustine H, Stein MJ, Al-Halabi B, Efanov JI, Morzycki A, Tang D, LeBlanc M, Binhammer P. Prospective Multicenter Randomized Controlled Trial Comparing Early Protected Movement and Splinting for Fifth Metacarpal Neck Fracture. Plast Surg (Oakv) 2022; 30:6-15. [PMID: 35096686 PMCID: PMC8793753 DOI: 10.1177/22925503211011952] [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: 02/03/2023] Open
Abstract
BACKGROUND Fifth metacarpal neck fractures account for 20% of all hand fractures, yet there remains debate with respect to management, particularly when conservative treatment is initiated. The objective of this study is to compare functional and patient-reported outcomes (PROs) in patients treated with early protected movement or splint immobilization. METHODS This national multicenter prospective randomized controlled trial compared 2 groups; elastic bandage with early protected movement versus immobilization with splinting. Demographic characteristics were collected at baseline. Functional outcomes (grip strength testing) and PROs (Brief Michigan Hand Questionnaire [bMHQ]) were collected at 4, 8, and 12 weeks post-intervention. Grip strength values of the injured hand were normalized to both the non-injured hand (at baseline), and the Canadian reference values. RESULTS Thirty-seven participants from 5 Canadian centers were randomized into the splint (n = 21) or elastic bandage group (n = 16). There were no significant differences in the bMHQ score between the splint (52.1 ± 27.2) or the elastic bandage (46.6 ± 20.4) groups (P = .51). There were no differences in baseline grip strength between the splint (15.3 ± 8.9 kg) and elastic bandage (19.9 ± 7.5 kg) groups. At 8 weeks, the elastic bandage group had a significantly higher grip strength than the splint group (93% vs 64%, respectively: P < .05), when standardized as a percentage of the Canadian reference values. CONCLUSION Patients with Boxer's fractures treated with early protected movement had better functional outcomes by 8 weeks post-treatment as compared to the Canadian reference values of those treated with immobilization and splinting. Providers should manage Boxer's fractures with early protected movement.
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Affiliation(s)
- Helene Retrouvey
- Division of Plastic and Reconstructive Surgery, Toronto, Ontario, Canada,Helene Retrouvey, MDCM, Division of Plastic and Reconstructive Surgery, University of Toronto, 149 College Street, Suite 508, Toronto, Ontario, Canada M5T 1P5.
| | - Josephine Jakubowski
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mona Al-Taha
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna Steve
- Division of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Haley Augustine
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael J. Stein
- Division of Plastic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Becher Al-Halabi
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Johnny Ionut Efanov
- Division of Plastic Surgery, Universite de Montreal, Montreal, Quebec, Canada
| | - Alexander Morzycki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David Tang
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin LeBlanc
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Binhammer
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
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A Fourteen-year Review of Practice Patterns and Evidence-based Medicine in Operative Metacarpal Fracture Repair. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4065. [PMID: 35186624 PMCID: PMC8849433 DOI: 10.1097/gox.0000000000004065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
The American Board of Plastic Surgery has been collecting practice data on metacarpal fracture operative repair since 2006 as part of its Continuous Certification process. These data allow plastic surgeons to compare their surgical experience to national trends. Additionally, these data present the opportunity to analyze those trends in relation to evidence-based medicine.
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Warrender WJ, Ruchelsman DE, Livesey MG, Mudgal CS, Rivlin M. Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures. Hand (N Y) 2020; 15:798-804. [PMID: 30894028 PMCID: PMC7850257 DOI: 10.1177/1558944719836214] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: There has been a recent increase in the use of headless compression screws for fixation of metacarpal neck and shaft fractures as they offer several advantages, and minimal complications have been reported. This study aimed to evaluate the clinical complications and their solutions following retrograde intramedullary headless compression screw fixation of metacarpal fractures. We describe complications and the approach to their management. Methods: We performed a multicenter case series through retrospective review of all patients treated with intramedullary headless screw fixation of metacarpal fractures by 3 fellowship-trained hand surgeons. Patient demographics, implant used, type of complication, pre- and postoperative radiographs, operative reports, and sequelae were reviewed for each case. We defined complications as infection, loss of fixation, hardware failure, malrotation, nonunion, malunion, metal allergy, and any repeat surgical intervention. Results: Four complications (2.5%) were identified through the review of 160 total metacarpal fractures. One complication was a nickel allergy, one was a broken screw after repeat trauma, and 2 patients had bent intramedullary screws. Screw removal in 3 patients was simple and without complications or persistent limitations. One bent screw with a refracture was left in place. No serious complications were seen. Conclusion: Intramedullary screw fixation of metacarpal fractures is safe with a low incidence of complications (2.5%) that can be safely and effectively managed.
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Affiliation(s)
- William J. Warrender
- Thomas Jefferson University, Philadelphia, PA, USA
- William J. Warrender, Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Fifth Floor, Philadelphia, PA 19107, USA.
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Sephien A, Bethel CF, Doyle CM, Gulick D, Smith CJ, Schwartz-Fernandes FA. Morphometric analysis of the second through fifth metacarpal through posteroanterior X-Rays. Clin Anat 2019; 33:1014-1018. [PMID: 31769105 DOI: 10.1002/ca.23528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/16/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022]
Abstract
Over the past 10 years, metacarpal fractures have had an annual incidence of 13.6 per 10,000 individuals. Literature has not reviewed anatomical variations through radiographic imaging, which may play a role in reducing postoperative complications. The purpose of this study was to use radiographic imaging to provide a detailed anatomy of the second through fifth metacarpals. This retrospective study measured length, neck width, narrowest body width, and narrowest medullary canal width of the second through fifth metacarpals through the use of posteroanterior X-rays. Patients who were ≥18 years and received hand radiographs from January 2015 to July 2019 were included in this study. Those with acute injury or fracture of the metacarpal were excluded. Five hundred and seventy-two metacarpals were included in this study, with 143 metacarpals measured each for the second through fifth metacarpal. The second metacarpal had the largest measured length, neck width, and narrowest body width at 68.72, 12.34, and 8.74 mm, respectively. The fifth metacarpal had the greatest average medullary canal width at 4.15 mm. This is the largest study in literature to comprehensively examine the anatomical variation of the second through fifth metacarpals. The second metacarpal had greatest dimensions except for canal width, which was the fifth metacarpal. Men almost consistently had greater metacarpal size when compared to women, and age was associated with second and third metacarpal canal width. The increased knowledge of metacarpal anatomy may potentially lay the foundation of further improvement of metacarpal implants and potentially reduce postoperative complications. Clin. Anat., 33:1014-1018, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew Sephien
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida.,USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Claire F Bethel
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida.,USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Catherine M Doyle
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida.,USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Danielle Gulick
- Department of Molecular Medicine, University of South Florida, Tampa, Florida
| | - Carson J Smith
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
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Melamed E, Joo L, Lin E, Perretta D, Capo JT. Plate Fixation versus Percutaneous Pinning for Unstable Metacarpal Fractures: A Meta-analysis. J Hand Surg Asian Pac Vol 2019; 22:29-34. [PMID: 28205483 DOI: 10.1142/s0218810417500058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Whether percutaneous pinning or plate fixation is more appropriate for metacarpal fractures is still open to debate. Our study purpose was to review the current literature in an attempt to determine the optimal treatment modality for metacarpal fractures on the basis of functional outcomes, radiographic outcome and rates of complications. METHODS We selected Pubmed, Cochrane library, EMBASE and the relevant English orthopedic journals and pooled data from eligible trials including four comparative studies and one retrospective review. Overall, the studies contained 222 patients with 231 fractures, 143 treated with pinning and 88 treated with plates and screws. Mean follow up was 7.5 months (4-12 months). Data were analyzed and the fixed effects are assumed for meta-analysis. RESULTS Patients undergoing pinning for metacarpal fractures have higher motion scores when compared to open reduction and internal fixation with plate and screws. Functional scores, grip strength, radiographic parameters, time to union and complications were found not to be significantly different between the two groups. CONCLUSIONS There is evidence to support the use of pins over ORIF with plates and screws in the treatment of metacarpal fractures. This may have practical advantages, including minimal dissection, easier insertion and availability of the pins. The limitations of this study include the small number of eligible studies, lack of reporting of standard deviation value, and the lack of DASH score assessments at follow up. Further randomized controlled trials that include a larger patient numbers with longer follow up are needed to substantiate the superiority of one fixation method over another.
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Affiliation(s)
- Eitan Melamed
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - LiJin Joo
- † Department of Biostatistics, Environmental Health Science Program, New York University, New York, NY, USA
| | - Edward Lin
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Donato Perretta
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - John T Capo
- * Division of Hand Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
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Vasilakis V, Sinnott CJ, Hamade M, Hamade H, Pinsky BA. Extra-articular Metacarpal Fractures: Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2261. [PMID: 31333977 PMCID: PMC6571303 DOI: 10.1097/gox.0000000000002261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no consensus on the optimal operative treatment of isolated closed metacarpal fractures as every technique is associated with advantages and shortcomings. This retrospective study aims to compare the outcomes of single metacarpal, extra-articular fractures treated with closed reduction and percutaneous pinning (CRPP) versus open reduction and internal fixation (ORIF). METHODS The charts of all patients who underwent surgical repair of closed metacarpal fractures at our institutions from 2009 to 2016 were reviewed. 70 patients met the inclusion criteria, 44 had undergone CRPP and 26 ORIF with plate or lag screws. Subgroup analyses of all patients stratified by both fracture pattern and fracture location were performed. Additionally, subgroup analyses of outcomes based on the time from injury to surgery were conducted. Clinical outcomes included immobilization time, total active motion, stiffness, complication and reoperation rates, as well as occupational therapy referral rates and duration. Functional outcomes were determined using the Quick-DASH (Disabilities of the Arm, Shoulder and Hand) score via telephone questionnaire administered retrospectively. RESULTS Overall, there was no significant difference in functional outcome parameters including total active motion (CRPP 91% of normal vs. ORIF 87% of normal), stiffness, therapy referrals, and complications between treatment groups. Patients treated with CRPP, regardless of fracture pattern or location, were operated on earlier than those treated with ORIF (avg. 7 days vs. 15 days). The immobilization time for patients treated with ORIF was significantly less than those treated with CRPP (19.7 vs. 30.7 days; p=0.001). This difference in the immobilization time also reflected the outcomes of the subgroup analyses based on the post-injury time of surgery. When transverse shaft fractures were examined independently as a subgroup, ORIF resulted in improved post-operative range of motion vs. CRPP (100% normal vs. 91% normal). The mean DASH score for each group was satisfactory and the difference was not statistically significant (16.3 for the CRPP and 18.7 for the ORIF group, p=0.805). CONCLUSION Both CRPP and ORIF are viable techniques with good clinical outcomes and low complication rates. ORIF of closed metacarpal fractures allowed for earlier mobilization when compared with CRPP without compromising fracture stability, clinical or functional short-term outcomes.
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Affiliation(s)
- Vasileios Vasilakis
- From the Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, N.Y
- Division of Plastic Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, N.Y
| | - Catherine J. Sinnott
- From the Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, N.Y
| | - Malack Hamade
- From the Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, N.Y
| | - Hassan Hamade
- From the Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, N.Y
| | - Brian A. Pinsky
- From the Long Island Plastic Surgical Group, 999 Franklin Avenue, Garden City, N.Y
- Division of Plastic Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, N.Y
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Pandey R, Soni N, Bhayana H, Malhotra R, Pankaj A, Arora SS. Hand function outcome in closed small bone fractures treated by open reduction and internal fixation by mini plate or closed crossed pinning: a randomized controlled trail. Musculoskelet Surg 2019; 103:99-105. [PMID: 29855782 DOI: 10.1007/s12306-018-0542-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE No study in literature clearly gives advantage of one method of surgical fixation of fracture over the other in metacarpal and phalangeal bones of hand comparing wider outcome measures. MATERIALS AND METHODS A randomized controlled trial between closed reduction and percutaneous Kirschner wire fixation or open reduction and internal fixation with mini fragment plates was conducted. A total of 32 patients with 16 in each group were taken in tertiary-level teaching hospital from 2014 to 2016. Four patients lost to follow-up apart from 32 studied. Inclusion criteria were age group 16-60 years, fresh (3 days) closed shaft fractures of metacarpal and phalanges. Outcome evaluated were time to union of fracture, degree of strength achieved measured with dynamometer, DASH scoring, range of motion of hand and each digit. RESULTS Both groups were comparable in terms of return to full hand function, union and total range of motion. K wire fixation results were slightly better than plating group in terms of early DASH score and grip strength after fixation. CONCLUSION No modality was found to be superior for fixation of small bone fractures of hand. But K wire being cheaper and without inherent complication of plating like scar and tendon irritation, K wire fixation is preferred over plating in shaft fractures of metacarpal and phalanges. LEVEL OF EVIDENCE Level I Therapeutic study.
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Affiliation(s)
- R Pandey
- University College of Medical Sciences, Delhi, India.
| | - N Soni
- Max Health Care, Delhi, India
| | - H Bhayana
- University College of Medical Sciences, Delhi, India
| | - R Malhotra
- University College of Medical Sciences, Delhi, India
| | - A Pankaj
- Fortis Shalimar Bagh, Delhi, India
| | - S S Arora
- Department of Orthopedic, AIIMS Rishikesh, Rishikesh, India
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical intervention is needed for metacarpal fractures. 3. Understand the various treatment options for surgical fixation of metacarpal fractures. 4. Describe the role for external fixation in managing difficult metacarpal fractures. BACKGROUND Metacarpal fractures are common injuries that plastic surgeons should be able to evaluate and treat. The goal of this review is to highlight current evidence for managing metacarpal fractures. This Continuing Medical Education article consists of a literature review, illustrations, videos, and an online Continuing Medical Education examination. METHODS The authors reviewed the scientific literature from 2000 to 2015 regarding treatment of metacarpal fractures. Cadaver models were used for instructional videography demonstrating common surgical techniques. Multiple-choice questions were created to review pertinent topics. A discussion and references are provided. RESULTS Numerous treatment options have been described for metacarpal fractures, including splinting, percutaneous fixation, open reduction with internal fixation, and external fixation. All modalities are acceptable strategies for treating metacarpal fractures. The ultimate goal is to maximize hand function with minimal morbidity. CONCLUSIONS A thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures. Although the current literature supports a wide array of treatment strategies, high-level evidence to guide fracture management remains lacking.
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Zhang B, Hu P, Yu KL, Bai JB, Tian DH, Zhang GS, Shao XZ, Zhang YZ. Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures. Orthop Surg 2017; 8:316-22. [PMID: 27627714 DOI: 10.1111/os.12271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/12/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures. METHODS Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013. Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement, fracture complexity, and surgeon's experience and were then treated accordingly. Relevant demographic, clinical and preoperative clinical data were collected and analyzed. Clinical examination and radiograph evaluation were performed 1 week and 1, 3, and 6 months postoperatively. Outcome measures were visual analog scale (VAS) scores for pain, total range of motion (ROM) of the injured digit, Quick Disabilities of the Arm, Shoulder, and Hand scores (Quick-DASH) and grip strength (percentage of the contralateral corresponding digit). RESULTS From July 2013 to September 2014, 76 patients were treated by AIM and 71 by ATLPS. Age, sex, time from injury to operation, dominant hand, injury mechanism, fracture location, fracture type and participant occupation were similar in both groups (P > 0.05). Operations were all performed well and followed by uneventful postoperative functional recoveries. At 3-month follow-up, all clinical outcomes were significantly better in the AIM than ATLPS group ( P < 0.05) except for VAS pain scores. However, at 6-month follow-up, the differences were no longer significant, indicating similar results for both types of fixation. Patients in the AIM group developed significantly more complications ( P = 0.037). Sick leave was significantly longer in the AIM group ( P = 0.02). CONCLUSIONS AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.
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Affiliation(s)
- Bing Zhang
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pan Hu
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kun-Lun Yu
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang-Bo Bai
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - De-Hu Tian
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gui-Sheng Zhang
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin-Zhong Shao
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Departments of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China. .,Departments of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
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Li G, Liu S, Chen G, Li Z, Liu Y, Sun G, Lu Q, Li X, Tan J, Guan M. Comparison of Clinical Outcomes of Phalangeal Fracture Treated with Dorsolateral Approach or Post-middle Approach Using AO Mini Titanium Plate. Indian J Surg 2016; 77:657-61. [PMID: 26730082 DOI: 10.1007/s12262-013-0968-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022] Open
Abstract
The aim of this study is to investigate the clinical outcomes of various fixation methods for proximal phalangeal fractures with Arbeitsgemeinschaft für Osteosynthesefragen (AO) mini titanium plate by dorsolateral approach or post-middle approach. Clinical results of 62 fingers of 53 patients with proximal phalangeal fracture were evaluated. For dorsolateral approach, the lateral bundle of the extensor tendon was drawn away to expose the fracture part of the bone. After reduction, the plate was located at the dorsolateral side of the bone. For post-middle approach, the extensor tendon was split to expose the fracture part of the bone. After reduction, the plate was fixed to the proximal phalangeal side of the bone, and the extensor tendon was repaired with 3-0 nonabsorbable silk sutures. We found low overall complication rates in both groups. The mean total active motion (TAM) for the dorsolateral group and post-middle group was 234.60° ± 22.63° and 221.08° ± 25.69°, respectively. There was a statistical significance between the two groups (P = 0.037 < 0.05), indicating that TAM was notably affected by various fixation methods. With AO mini titanium plate, movement in dorsolateral approach group was significantly higher than in post-middle approach group. Dorsolateral approach is an acceptable technique of incision for proximal phalangeal fractures.
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Affiliation(s)
- Guang Li
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Shen Liu
- Department of Orthopaedics, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, 200233 China
| | - Guoting Chen
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Zengchun Li
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Yangzhou Liu
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Guixin Sun
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Qingyou Lu
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Xia Li
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Jun Tan
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
| | - Ming Guan
- Department of Emergency Trauma, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120 China
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Oberreiter B, Kilgus M, Bodmer E, Platz A. [Osteosynthesis of metacarpal fractures with 2.0 mm LCP system and functional postoperative treatment]. Unfallchirurg 2015; 120:40-45. [PMID: 26070731 DOI: 10.1007/s00113-015-0023-x] [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: 11/26/2022]
Abstract
BACKGROUND Locking head systems are an additional option in the surgical treatment of metacarpal fractures. In this clinic 2.0 mm locking compression plates (LCP) are used, which provide the possibility of functional postoperative treatment even for complex and osteoporotic metacarpal fractures. For simple fractures and good bone quality the LCP system is used as a compression or neutralization plate. Depending on the type and localization of the fracture, different osteosynthesis techniques are used in order to achieve a functional postoperative treatment in as many patients as possible. MATERIAL AND METHODS Between July 2009 and December 2010 a total of 49 patients were enrolled in a prospective trial. All patients underwent surgical treatment with a 2.0 mm LCP system. Postoperative functionality of the hand was restored without immobilization. Clinical and radiological examinations were performed after 6 and 12 weeks and after 6 and 12 months with documentation of the range of motion (ROM), grip strength, fingertip to palm distance and the disabilities of the arm, shoulder and hand (DASH) score. RESULTS After 6 months a good functional result was achieved in all patients with no cases of malrotation. Radiographs showed a completely consolidated bone healing. CONCLUSION After osteosynthesis with 2.0 mm LCPs all types of metacarpal fractures can be treated without immobilization.
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Affiliation(s)
- B Oberreiter
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz.
| | - M Kilgus
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| | - E Bodmer
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| | - A Platz
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
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Abstract
Metacarpal fractures comprise between 18-44 % of all hand fractures. Non-thumb metacarpals account for around 88 % of all metacarpal fractures, with the fifth finger most commonly involved [19]. The majority of metacarpal fractures are isolated injuries, which are simple, closed, and stable. While many metacarpal fractures do well without surgery, there is a paucity of literature and persistent controversy to guide the treating physician on the best treatment algorithm. The purpose of this article is to review non-thumb metacarpal anatomy and treatment protocols for nonoperative management of stable fractures, and compare existing literature on surgical techniques for treatment of acute fractures and complications.
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Affiliation(s)
- Kathleen M. Kollitz
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105 USA ,Duke University School of Medicine, DUMC 2927, Durham, NC 27710 USA
| | - Warren C. Hammert
- Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
| | - Nicholas B. Vedder
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105 USA
| | - Jerry I. Huang
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105 USA
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Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013; 38:1021-31; quiz 1031. [PMID: 23618458 DOI: 10.1016/j.jhsa.2013.02.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 02/02/2023]
Abstract
Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases. We present a review of hand fracture management, with special attention paid to advances since 2008. The history and mechanisms of these fractures are discussed, as are treatment options and common complications. Early mobilization of the fractured hand is emphasized because soft tissue recovery may be more problematic than that of bone.
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Affiliation(s)
- Clifton Meals
- Department of Orthopedics, George Washington University Medical Center, Washington, DC, USA.
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Haughton D, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture management. Open Orthop J 2012; 6:43-53. [PMID: 22423303 PMCID: PMC3296112 DOI: 10.2174/1874325001206010043] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 10/28/2011] [Accepted: 10/29/2011] [Indexed: 01/17/2023] Open
Abstract
The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities.A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management.
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Affiliation(s)
- Dn Haughton
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road Chester, CH21UL. UK
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21
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Soni A, Gulati A, Bassi JL, Singh D, Saini UC. Outcome of closed ipsilateral metacarpal fractures treated with mini fragment plates and screws: a prospective study. J Orthop Traumatol 2011; 13:29-33. [PMID: 22080220 PMCID: PMC3284659 DOI: 10.1007/s10195-011-0166-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 10/24/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Closed multiple metacarpal fractures are considered highly unstable and are more prone to poor functional outcome. The authors assess the functional outcome of mini fragment plate fixation in closed ipsilateral multiple metacarpal fractures. PATIENTS AND METHODS In 21 patients with closed ipsilateral multiple metacarpal fractures treated with open reduction and internal fixation using mini fragment plate, functional outcome was assessed using the American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) scoring system. RESULTS Union rate of 100% was achieved. Functional outcome was excellent in 85.71% (18 of 21) and good in 9% (2 of 21) of patients. Average DASH score was 8.47 (range 1-26). Five cases of infection (two deep, three superficial) were reported, which subsided with dressings and antibiotics. CONCLUSIONS Plate fixation is a good option for treating closed ipsilateral multiple metacarpal fractures, providing rigid fixation for early mobilization and good functional outcome.
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Affiliation(s)
- Ashwani Soni
- Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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23
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Givissis PK, Stavridis SI, Papagelopoulos PJ, Antonarakos PD, Christodoulou AG. Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment. Clin Orthop Relat Res 2010; 468:3377-83. [PMID: 20473595 PMCID: PMC2974869 DOI: 10.1007/s11999-010-1388-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 04/30/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions. QUESTIONS/PURPOSES This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown? PATIENTS AND METHODS Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months). RESULTS Fracture healing was uneventful in all cases. Four patients experienced a foreign-body reaction during the second postoperative year and required surgical débridement to remove implant remnants. Histologic examination confirmed the diagnosis of a foreign-body reaction. Two other patients reported a transient local swelling that subsided without treatment. CONCLUSIONS Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer.
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Affiliation(s)
- Panagiotis K. Givissis
- 1st Department of Orthopaedics, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece ,Aristotle University of Thessaloniki, 9 Papanikolaou Street, Panorama, Mail Box 215, 55210 Thessaloniki, Greece
| | - Stavros I. Stavridis
- 1st Department of Orthopaedics, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | | | - Petros D. Antonarakos
- 1st Department of Orthopaedics, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Anastasios G. Christodoulou
- 1st Department of Orthopaedics, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
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Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? Orthop Traumatol Surg Res 2010; 96:506-12. [PMID: 20580630 DOI: 10.1016/j.otsr.2010.02.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 09/23/2009] [Accepted: 02/16/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. HYPOTHESIS The present study compared results between locking plates and intramedullary K-wires. MATERIAL AND METHODS The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). RESULTS No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). DISCUSSION Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks' immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. LEVEL OF EVIDENCE Level IV continuous prospective comparative study.
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Affiliation(s)
- S Facca
- Orthopedic and Hand Surgery Dept, SOS Hand Group Practice, Strasbourg University Hospitals, 10, avenue Achille-Baumann, 67403 Illkirch cedex, France
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Abstract
Locked fixed-angle plating in the hand and wrist helps to optimize outcomes following surgical fixation of select acute fractures and complex reconstructions. Select indications include unstable distal ulna head/neck fractures, periarticular metacarpal and phalangeal fractures, comminuted/multifragmentary diaphyseal fractures with bone loss (ie, combined injuries of the hand), osteopenic/pathologic fractures, nonunions and corrective osteotomy fixation, and small joint arthrodesis. Locked plating techniques in the hand should not be seen as a panacea for wrist and digital acute trauma and delayed reconstructions. An understanding of the biomechanics of fixed-angle plating and proper technical application of locking constructs will optimize outcomes and minimize complications. As clinical experience with locking technology in hand trauma broadens, new indications and applications will emerge. Currently, several systems are available. The specific implants share common features in their protocols for insertion, but unique differences in their design (ie, individual locking mechanisms, uniaxial vs polyaxial locking capability, metallurgy, and plate profiles) must be appreciated and considered preoperatively.
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Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010; 35:1260-3. [PMID: 20619555 DOI: 10.1016/j.jhsa.2010.04.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 04/24/2010] [Accepted: 04/28/2010] [Indexed: 02/02/2023]
Abstract
This case report describes an alternative technique for the fixation of displaced comminuted subcapital fractures of the metacarpal with limited distal bone stock. Using a cannulated headless screw as an intramedullary device placed through the articular surface, we were able to secure proximal and distal bone purchase without excessive soft tissue stripping or disruption of the fracture hematoma. This technique allows early rehabilitation, and our patient went on to uneventful healing with excellent functional results.
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Affiliation(s)
- Christina L Boulton
- Harvard Combined Orthopaedic Residency Program and Department of Orthopaedic Surgery, Harvard Medical School, Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
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