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Siriwittayakorn W, Adulkasem N, Sangthongsil P, Pitiguagool W, Atthakorn W, Watatham K, Siritattamrong W. Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization. Adv Orthop 2023; 2023:1439011. [PMID: 37877095 PMCID: PMC10593546 DOI: 10.1155/2023/1439011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
Objective This study aims to evaluate the outcomes of single intramedullary K-wire fixation in nonthumb, metacarpal shaft fractures with immediate postoperative hand mobilization without any immobilization. Method This is a retrospective case series conducted from January 2019 to December 2022. We included patients with closed, simple transverse, or short oblique metacarpal shaft fracture treated with single, 1.4 mm, intramedullary K-wire fixation. Gentle postoperative range of motion exercise was encouraged in every patient without any hand, finger, or wrist motion restriction material. Clinical outcomes were evaluated with total active flexion; grip strength; disability of arm, shoulder, and hand (DASH) score; and the American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. Results This study included 34 patients, 25 males and 9 females with a mean age of 33.14 years (ranging 18-59). A total of 43 metacarpal shafts were treated. The mean DASH score at two and 6 weeks postoperative was 41.5 (ranging 19.16-60.34) and 9.58 (ranging 0.83-23.27). The mean final DASH score at last follow-up was 3.48 (ranging 0-8.33). Mean TAF at 2 weeks postoperative, 6 weeks postoperative, and at final follow-up was 203.8 (ranging 185-240), 238.2 (ranging 220-270), and 259.25 (ranging 240-270) degrees, respectively. The mean grip strength of the injured hand was 66.14 and 86.1% of the uninjured hand at 6 weeks and 3 months postoperative. There was no nonunion, malrotation, or infection. In conclusion, single intramedullary K-wire fixation gives excellent outcomes in the treatment of single or multiple, simple, metacarpal shaft fractures without the need of postoperative immobilization.
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Affiliation(s)
| | - Nath Adulkasem
- Department of Orthopaedics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | | | | | | | - Kraisong Watatham
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Wang K, Du W, Deng C, Hu N, Zhuang W. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. J Int Med Res 2023; 51:3000605231174981. [PMID: 37243605 DOI: 10.1177/03000605231174981] [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: 05/29/2023] Open
Abstract
OBJECTIVE This retrospective study compared two minimally invasive surgical methods for fifth metacarpal neck fractures in adolescents: percutaneous Kirschner wire (K-wire) fixation and elastic stable intramedullary nailing (ESIN). METHODS This study involved 42 adolescents aged 11 to 16 years with fifth metacarpal neck fractures treated by either K-wire fixation (n = 20) or ESIN (n = 22). The palmar tilt angle and shortening were compared on radiographs preoperatively and 6 months postoperatively. Total active range of motion (TAM), the visual analogue scale score for pain, and the Disabilities of the Arm, Shoulder and Hand score for upper limb function were recorded at 5 weeks, 3 months, and 6 months postoperatively. RESULTS The mean TAM was significantly greater in the ESIN than K-wire group at all postoperative time points. The mean external fixation time was 2 weeks longer in the K-wire than ESIN group. One patient in the K-wire group developed infection. There was no statistically significant difference between the two groups in other postoperative outcomes. CONCLUSIONS ESIN fixation has the advantages of greater stability, better activity, a shorter external fixation time, and a lower infection rate than K-wire fixation in the treatment of fifth metacarpal neck fractures in adolescents.
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Affiliation(s)
- Kai Wang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Weibin Du
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Changzong Deng
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Ningrui Hu
- Hubei Chinese Medical University, Wuhan, China
| | - Wei Zhuang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
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Abstract
In recent decades, there has been a trend toward increased use of operative treatment of hand fractures. However, internal stabilization with wires or open reduction and internal fixation of the phalanges and the metacarpals carries a risk of surgical complications that can be avoided by using appropriate conservative treatment. In this article, some hand fractures that can be managed safely without surgery are discussed. In conclusion, when facing a fracture in the hand, the first consideration is whether the fracture can be treated nonoperatively and not which operative treatment is most appropriate. This applies to both displaced and undisplaced fractures.
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FİDAN F, ÇETİN MÜ. Fifth metacarpal neck fracture fixation: antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1116129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: The present study aimed to compare clinical and radiological outcomes in patients with displaced fifth metacarpal neck fractures after treatment with antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning.
Material Method: While seventeen patients were treated with antegrade intramedullary pinning (Group ), 14 were treated with percutaneous retrograde crossed pinning (Group 2). Clinical and radiological outcomes included Quick Dash, active range of motion (ROM), VAS, and dorsal angulation loss at weeks four and twelve and in the final follow-up.
Results: The findings revealed that the groups had mean ages of 29.41±8.15 years and 27.78±7.42 years, res-pectively. While ROM was better in Group 2 at weeks four and twelve, we could not find a significant difference between the groups by active ROM in the final follow-up. Moreover, Group 1 had a better Dash score in the fourth week and twelth week , but both groups had similar Dash scores in the final follow-up. Finally, the groups had no preoperative and postoperative differences radiologically.
Conclusion: The present findings uncovered that treatment of a displaced fifth metacarpal neck fracture by anteg-rade intramedullary pinning yielded a better in the first three months improvement in active ROM and Quick Dash than percutaneous retrograde crossed pinning.
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Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskelet Disord 2021; 22:546. [PMID: 34130660 PMCID: PMC8204464 DOI: 10.1186/s12891-021-04436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04436-w.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.,Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Jian Wang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - De-Hua Zhang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Feng Mao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Yi Liao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
| | - Rui Xiao
- Department of Surgical Center, Karamay Central Hospital of Xinjiang, 834000, Karamay, China. .,Karamay District Center for Disease Control and Prevention , 834000, Karamay, China.
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Zeng L, Zeng L, Miao X, Chen Y, Liang W, Jiang Y. Single versus dual elastic nails for closed reduction and antegrade intramedullary nailing of displaced fifth metacarpal neck fractures. Sci Rep 2021; 11:1778. [PMID: 33469102 PMCID: PMC7815815 DOI: 10.1038/s41598-021-81242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/29/2020] [Indexed: 11/09/2022] Open
Abstract
Closed reduction and internal fixation with antegrade intramedullary nails is a feasible and effective treatment for displaced fifth metacarpal neck fractures (FMNFs). The present study aimed to compare clinical and radiological outcomes in patients with displaced FMNFs after treatment with single or dual antegrade elastic intramedullary nails (AEIMNs). Thirty-three patients were treated with a single 2.0 mm AEIMN and 34 patients were treated with two 1.5 mm AEIMNs. Clinical and radiological outcomes included grip strength, active range of motion (ROM), active flexion and extension of the fifth metacarpophalangeal (MCP) joint, dorsal angulation loss, and metacarpal shortening of the fifth metacarpal at 12 months after treatment. No significant difference was observed between the two groups with respect to grip strength, ROM or flexion of the fifth MCP joint. The average values of dorsal angulation loss, metacarpal shortening, and extension of the fifth MCP joint of the dual nails group were better than those of the single nail group (dorsal angulation loss, 2.79 ± 1.93° vs. 4.05 ± 1.59°, P = 0.009; metacarpal shortening, 1.66 ± 0.80 mm vs. 2.12 ± 0.88 mm, P = 0.028; extension of the fifth MCP joint, 7.71 ± 4.43° vs. 4.82 ± 4.09°, P = 0.012). In conclusion, dual AEIMNs fixation provided better MCP extension and radiological outcomes than single AEIMN fixation.
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Affiliation(s)
- Langqing Zeng
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Lulu Zeng
- Department of Anesthesiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Xiaogang Miao
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China
| | - Yunfeng Chen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weiguo Liang
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Yuwen Jiang
- Department of Orthopaedics, Zhuhai People's Hospital, Zhuhai Hospital Affiliated With Jinan University, Guangdong, China.
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Boeckstyns MEH. Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically. J Hand Surg Eur Vol 2021; 46:30-36. [PMID: 33135525 DOI: 10.1177/1753193420968040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.
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Sadek AF. Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures. J Hand Microsurg 2019; 12:189-196. [PMID: 33408445 DOI: 10.1055/s-0039-3399481] [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: 10/25/2022] Open
Abstract
Introduction When dealing with metacarpal neck fractures, the aim of treatment should include clinical and radiological objectives. The aim of this study was to assess the efficacy of flexible stable intramedullary nailing for the management of metacarpal neck fractures. Materials and Methods A total of twenty four patients (22 males and 2 females; mean age: 28.2 ± 7.7 years) with metacarpal neck fractures (second in 7 patients and fifth in 17 patients) whether isolated or associated with other body injuries and managed by percutaneous flexible stable intramedullary nailing were reviewed for a retrospective case series. Personal interviews were conducted together with clinical and radiological assessments. The final results were recorded at the time of personal interviews. Results The mean duration of surgery was 19.3 ± 2.5 minutes. The mean time of radiological union was 5 ± 1.3 weeks. The mean postoperative active range of motion of the metacarpophalangeal joint was 102.4 ± 11 degrees. The mean supination power of the involved hand in comparison to the contralateral side was 97.8 ± 3.4%, whereas the pronation power percentage was 99.2% ± 1.6. The mean power grip percentage to the contralateral side was 96.4 ± 2.9%, whereas the mean percentage of the pinch grip was 96.1 ± 4.2%. The mean postoperative DASH (Disability of Arm, Shoulder, and Hand) score was 0.3 ± 0.5. Conclusion Percutaneous flexible stable intramedullary nailing for the treatment of metacarpal neck fractures has expanded the armamentarium of the orthopaedic surgeons as an easy, cost-effective technique overcoming all possible deformities and allowing early and reliable active rehabilitation. Level of Evidence This is a Type IV, therapeutic retrospective case series.
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Affiliation(s)
- Ahmed Fathy Sadek
- Department of Orthopaedic Surgery, Minia University Hospital, Minia, Egypt
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Eisenschenk A, Spitzmüller R, Güthoff C, Obladen A, Kim S, Henning E, Dornberger JE, Stengel D. Single versus dual Kirschner wires for closed reduction and intramedullary nailing of displaced fractures of the fifth metacarpal neck (1-2 KiWi): a randomized controlled trial. Bone Joint J 2019; 101-B:1263-1271. [PMID: 31564142 DOI: 10.1302/0301-620x.101b10.bjj-2019-0410.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.
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Affiliation(s)
- Andreas Eisenschenk
- Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Romy Spitzmüller
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claas Güthoff
- Centre for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Adrian Obladen
- Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Esther Henning
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jenny E Dornberger
- Burn Centre and Department of Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Dirk Stengel
- Department of Research, Business Division Medicine, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
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Akinleye SD, Garofolo-Gonzalez G, Culbertson MD, Choueka J. Iatrogenic Injuries in Percutaneous Pinning Techniques for Fifth Metacarpal Neck Fractures. Hand (N Y) 2019; 14:386-392. [PMID: 28933198 PMCID: PMC6535944 DOI: 10.1177/1558944717731858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is little information regarding anatomic structures at risk during closed percutaneous treatment of fifth metacarpal neck fractures. This study evaluates a variety of common percutaneous techniques with the hypothesis that each approach presents unique risks to tendons and neurovascular structures. METHODS Seven cadaveric hands were used for this study. The senior author, a board-certified hand surgeon with more than 20 years of experience, used a mini-C arm to pass 1.6-mm Kirschner wires (K-wires). The 4 percutaneous techniques employed were anterograde, retrograde, cross-pinning, and transverse fixations. Meticulous superficial dissection was carried out, with fixation from all 4 techniques left in place, to identify any tendons or neurovascular structures penetrated by the K-wires. RESULTS All techniques demonstrated penetration of at least 1 adjacent structure. The anterograde technique showed penetration of the extensor carpi ulnaris tendon in 5 out of 7 cadavers. In the retrograde approach, the K-wire impaled either the extensor digitorum communis or the extensor digitorum minimi tendons in 4 out of 7 cadavers. The transverse pinning technique exhibited injury to the dorsal cutaneous ulnar nerve in 2 of the specimens. In the retrograde cross-pin technique, there were 2 penetrations of the digital branch of the dorsal cutaneous ulnar nerve. CONCLUSIONS None of the described percutaneous techniques for treating fifth metacarpal neck fractures eliminate the potential for damage to surrounding tendons or nerves. Each technique has at risk structures that the treating surgeon should be aware of in order to anticipate potential complications and counsel patients accordingly.
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Affiliation(s)
- Sheriff D. Akinleye
- Maimonides Medical Center, Brooklyn, NY,
USA,Sheriff D. Akinleye, Department of
Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY
11219, USA.
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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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Assi C, Mansour J, Samaha C, Ajjoub S, Yammine K. A single antegrade intramedullary k-wire for fifth metacarpal neck fractures. Eur J Trauma Emerg Surg 2019; 46:389-395. [PMID: 30617399 DOI: 10.1007/s00068-018-01073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Antegrade intramedullary nailing (AIMN) using 2k-wires seems to be superior to other modalities in treating displaced fractures of the fifth metacarpal neck (FFMN). Few reports demonstrated similar results retrospective with a single k-wire. The aim of the study is to describe our single k-wire technique and evaluate the related results. METHODS This is a retrospective study of a continuous series of patients treated with a single intramedullary k-wire for FFMN. It includes 30 patients who met the criteria for surgery: a dorsal angulation of more than 30°, malrotation, or both. The mean clinical follow-up period was 7 ± 14.9 months. RESULTS The mean pre-operative angle was 50° ± 11.35° and the mean immediate post-operative angle was 4.86° ± 2.8°. The mean immediate correction was 47° ± 9.3°. The mean correction at last follow-up was 45.14° ± 8.55°. Healing was obtained in all patients and bone union was achieved at a mean of 5.6 ± 1.2 weeks. The mean operative time was 8.5 min. The mean C-arm usage (number of clicks) was 7.2 times. The mean exposure radiation time was calculated at 3.6 s. The mean radiation dose was 0.08 mGy/mm2. The mean satisfaction score was 1.26 ± 0.45. Quick-DASH and EQ-5D scores yielded excellent values. CONCLUSIONS With potential benefits like lesser surgical time, radiation and cost, the use of a single AIMN could be safer, quicker and cheaper while reproducing similar clinical, functional and radiological outcomes to those reported with the use of 2k-wires.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Sleiman Ajjoub
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon.
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13
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Comparison of Hematoma Block and Wrist Block in the Treatment of Fracture of Neck of Fifth Metacarpus. Trauma Mon 2018. [DOI: 10.5812/traumamon.67616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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