1
|
Lambi AG, Rowland RJ, Brady NW, Rodriguez DE, Mercer DM. Metacarpal fractures. J Hand Surg Eur Vol 2023; 48:42S-50S. [PMID: 37704027 DOI: 10.1177/17531934231184119] [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: 09/15/2023]
Abstract
Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.
Collapse
Affiliation(s)
- Alex G Lambi
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Robert J Rowland
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - Nicholas W Brady
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Diego E Rodriguez
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Deana M Mercer
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| |
Collapse
|
2
|
Heifner JJ, Rubio F. Fractures of the phalanges. J Hand Surg Eur Vol 2023; 48:18S-26S. [PMID: 37704026 DOI: 10.1177/17531934231185219] [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: 09/15/2023]
Abstract
Fractures of the phalanges encompass a wide range of injury patterns with variable articular and soft tissue involvement. The goals of treatment whether conservative or surgical are the restoration of function while limiting the risk of complications. An armamentarium of fixation options allows the surgeon to appropriately treat these fractures with the intention of initiating early postoperative mobilization. Previous publications report variable rates of complications following internal fixation of phalangeal fractures which represents an unsolved problem. It is incumbent on the surgeon to utilize meticulous surgical technique, achieve anatomic reduction with stable fixation and initiate early postoperative mobilization where indicated. In the following text, we review the management of most types of phalangeal fractures, except fracture-dislocations of the proximal interphalangeal joint. These injuries comprise a wide spectrum of presentation; thus, an understanding of anatomical and mechanical principles is integral to achieving a successful outcome.
Collapse
|
3
|
Wellborn PK, Allen AD, Draeger RW. Current Outcomes and Treatments of Complex Phalangeal and Metacarpal Fractures. Hand Clin 2023; 39:251-263. [PMID: 37453755 DOI: 10.1016/j.hcl.2023.02.002] [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: 07/18/2023]
Abstract
Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are stiffness and malunion. These can be highly challenging problems for the hand surgeon. In this article, we discuss complications after phalangeal and metacarpal fractures and treatment strategies for these complications.
Collapse
Affiliation(s)
- Patricia K Wellborn
- Department of Orthopaedics, University of North Carolina School of Medicine, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC 27599-7055, USA
| | - Andrew D Allen
- Department of Orthopaedics, University of North Carolina School of Medicine, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC 27599-7055, USA
| | - Reid W Draeger
- Department of Orthopaedics, University of North Carolina School of Medicine, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC 27599-7055, USA.
| |
Collapse
|
4
|
Ma X, Wang L, Zhang X, Zhang Z, Xu Y, Lv L, Shao X. Comparative study of K-wire combined with screw vs. K-wire in the treatment of AO type B3.1 phalangeal fractures. BMC Musculoskelet Disord 2023; 24:591. [PMID: 37468856 DOI: 10.1186/s12891-023-06731-0] [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: 01/04/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The purpose of this study was to introduce the surgical method of K-wire combined with screw in the treatment of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type B3.1 phalangeal fractures and to compare its clinical, radiological and functional outcomes with K-wire fixation. METHODS This was a retrospective comparative study. From January 2015 to February 2022, we treated 86 patients with AO type B3.1 phalangeal fractures. A total of 71 patients were finally included in the statistical analysis. Thirty-nine patients received K-wires combined with screw, and 32 patients received simple K-wires. The follow-up time was at least 6 months. Outcome measures included general information, operative time, total active motion (TAM), pinch strength, radiological union time, pain assessed by visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, cost, and complications. RESULTS The follow-up time was 6-12 months, with an average of 7.9 months. All patients achieved clinical and radiological union. Compared with the K-wire fixation group, the TAM, radiological union time and VAS score of the K-wire combined with screw group had obvious advantages. Compared with the opposite healthy hand, the grip strength of the two groups was similar, and there was no significant difference in the QuickDASH score. The incidence rate of complications in the K-wire combined with screw group (2/39) was lower than that in the K-wire fixation group (7/32). CONCLUSIONS Compared with simple K-wire fixation, K-wire combined with screw in the treatment of AO type B3.1 phalangeal fractures is a safer and reliable surgical method. K-wire controls the rotation and plays a role similar to a "lock". The screw can exert pressure and fix it more firmly. It shortens the time of fracture healing and has a higher TAM and fewer postoperative complications.
Collapse
Affiliation(s)
- Xuelin Ma
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Wang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaoran Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhemin Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yali Xu
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Lv
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xinzhong Shao
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| |
Collapse
|
5
|
Vervloesem N, Glassey N, Kerr A. Rehabilitation following extra-articular proximal phalangeal fractures of the fingers in adults: a scoping review. HAND THERAPY 2023; 28:45-59. [PMID: 37904862 PMCID: PMC10584068 DOI: 10.1177/17589983231155270] [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: 11/06/2022] [Accepted: 01/19/2023] [Indexed: 11/01/2023]
Abstract
Introduction Proximal phalangeal fractures are common and can have a significant impact on hand function. Therefore, it is important to optimise post-operative rehabilitation. A scoping review was undertaken to map the existing evidence on rehabilitation of proximal phalangeal fractures of the fingers in adults. Methods A comprehensive search was conducted which included database searching, reference searching, hand searching of journals, and searching for grey literature. Eight articles were included after screening for eligibility. Results Three studies researched surgical interventions and five studies conservative management. The immobilisation period varied between 5 days to 3 weeks in the surgical studies, and between 3 to 7 weeks in the conservative studies. Active exercise therapy was started immediately with conservative management, while in the surgical studies time to commence exercises varied between 5 days and 3 weeks. All studies reported good results in mobility with a mean total active motion ranging from 240° to 258.9°. Patients reported little pain at final follow-up and grip strength recovered to 96% compared to the unaffected side. Studies reporting on function and patient satisfaction lacked transparency. Conclusions All studies had a moderate to high risk of bias and the results of the included studies should therefore be interpreted with caution. More high-quality randomised controlled studies with an a priori research protocol and a standard set of outcome measures are necessary to research whether early motion, an intrinsic plus splint leaving the wrist free, and the inclusion of additional treatment modalities can result in a better and/or faster recovery.
Collapse
Affiliation(s)
- Nele Vervloesem
- The University of Derby, UK
- Biomedical Sciences Group, Locomotor and Neurological Disorders, Katholieke Universiteit Leuven, Belgium
| | | | | |
Collapse
|
6
|
Effect of Joint Use of External Minifixator and Titanium Lockplate on Total Active Motion Range and Hand Function Recovery in Comminuted Metacarpal and Phalanx Fracture Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3566364. [PMID: 35126920 PMCID: PMC8808207 DOI: 10.1155/2022/3566364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 12/31/2022]
Abstract
Objective To explore the effect of joint use of external minifixator and titanium lockplate on total active motion (TAM) range and hand function recovery in comminuted metacarpal and phalanx fracture patients. Methods The medical data of 70 patients with comminuted metacarpal and phalanx fracture treated in our hospital from June 2017 to June 2020 were screened for the retrospective study, and the patients were divided into the control group (Kirschner wire internal fixation) and the study group (an external minifixator with titanium lockplate) according to the treatment modalities, with 35 cases each. After treatment, the clinical efficacy of patients was compared between the two groups. Results No between-group differences in patients' general data were observed (P > 0.05); the time for hospital stay and fracture healing was obviously shorter in the study group than that in the control group (P < 0.05); after treatment, the study group obtained significantly higher TAM range good rate (P < 0.05), significantly higher Carroll hand function test pass rate (P < 0.05), and obviously better grip strength of both hands and score on digital opposition of thumb than those in the control group (P < 0.05); and after surgery, the study group had significantly lower incidence rates of complications such as infection, local inflammation, displacement of bone, and adhesion of tendon that those in the control group (P < 0.05). Conclusion Joint use of an external minifixator and titanium lockplate can effectively promote the TAM range and accelerate hand function recovery for comminuted metacarpal and phalanx fracture patients and is conducive to reducing the incidence of postoperative complications, which is safe and has significant efficacy.
Collapse
|
7
|
Zorli IP, Lucchina S. Comments on "finger pulp reconstruction with thenar flap: Aesthetic and functional outcome"-----relevant questions demanding attention related to the study. Chin J Traumatol 2021:S1008-1275(21)00120-6. [PMID: 34353639 DOI: 10.1016/j.cjtee.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/31/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ilaria Papini Zorli
- Department of Hand Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Lucchina
- Hand Unit EOC, General Surgery and Traumatology Department, Locarno's Regional Hospital, Via all'Ospedale 1, 6600, Locarno, Switzerland; Locarno Hand Center, Via Ramogna 16, 6600, Locarno, Switzerland.
| |
Collapse
|
8
|
Abstract
In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.
Collapse
|