1
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Anene CC, Thomas TL, Matzon JL, Jones CM. Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review. J Hand Surg Am 2024; 49:1043.e1-1043.e16. [PMID: 36878755 DOI: 10.1016/j.jhsa.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures. METHODS A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data. RESULTS Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery. CONCLUSIONS Complications following IMS fixation of metacarpal fractures are relatively uncommon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Chibuzo C Anene
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Terence L Thomas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jonas L Matzon
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Christopher M Jones
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA.
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2
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Noble DM, Dacus AR, Chhabra AB. Advances in the Treatment of Hand and Wrist Injuries in the Elite Athlete. J Hand Surg Am 2024; 49:779-787. [PMID: 38775759 DOI: 10.1016/j.jhsa.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 08/05/2024]
Abstract
Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete.
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Affiliation(s)
- David Matthew Noble
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Angelo Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Abhinav Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
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3
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Chambers SB, Thompson DJ, Schaeffer CV, Graf AR, Wagner E, Gottschalk MB, Seiler JG, Suh N. Determining the Optimal Intramedullary Screw Canal Fill Ratio in Length Unstable Metacarpal Fractures: A Biomechanical Investigation. J Hand Surg Am 2024:S0363-5023(24)00150-3. [PMID: 39007799 DOI: 10.1016/j.jhsa.2024.03.017] [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: 10/12/2023] [Revised: 02/24/2024] [Accepted: 03/20/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Intramedullary (IM) screw fixation is gaining popularity in the treatment of metacarpal fractures. Despite its rapid adoption, there is a paucity of evidence regarding parameters to optimize effectiveness. This study aimed to quantify the relationship between stability, IM screw size, and canal fill using a cadaveric model. METHODS Thirty cadaveric metacarpals (14 index, 13 middle, and three ring fingers; mean age: 58.3 years, range: 48-70) were selected to allow for canal fill ratios of 0.7-1.1 for screws sized 3.0, 3.5, and 4.5 mm. Metacarpals underwent a 45° volar-dorsal osteotomy at the midpoint before fixation with an IM screw. Specimens were subjected to 100 cycles of loading at 10 N, 20 N, and 30 N before load-to-failure testing. Correlation coefficients for angular displacement on the final cycle at each load, peak load to failure, and average stiffness were assessed. RESULTS Correlation coefficients for the angular displacement on the 100th cycle were as follows: 10 N, R = 0.62, 20 N, R = 0.57, and 30N, R = 0.58. Correlation values for peak load to failure as a function of canal fit were as follows: 3.0 mm, R = 0.5, 3.5 mm, R = 0.17, and 4.5 mm, R = 0.44. The canal fill ratio that intersected the line-of-best fit at an angular deformity of 10° was 0.74. Average peak forces for 3.0-, 3.5-, and 4.5-mm screws were 79.5, 136.5, and 179.6 N, respectively. Average stiffness for each caliber was 14.8, 33.4, and 52.3 N/mm. CONCLUSIONS Increasing screw diameter and IM fill resulted in more stable fixation, but marginal gains were seen in ratios >0.9. A minimum fill ratio of 0.74 was sufficient to withstand forces of early active motion with angular deformity <10°. CLINICAL RELEVANCE An understanding of the relationship of IM fill ratio of metacarpal screws to fracture stability may provide a framework for clinicians to optimally size these implants.
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Affiliation(s)
- Spencer B Chambers
- Department of Plastic & Reconstructive Surgery, Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Dan J Thompson
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | | | | | - Eric Wagner
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | | | | | - Nina Suh
- Emory University, Department of Orthopedic Surgery, Atlanta, GA.
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Chiu YC, Ho TY, Hsu CE, Yeh CW, Ting YN, Tsai MT, Hsu JT. Biomechanical analysis of plate versus K-wire fixation for metacarpal shaft fractures with wedge-shaped bone defects. BMC Musculoskelet Disord 2024; 25:350. [PMID: 38702748 PMCID: PMC11067226 DOI: 10.1186/s12891-024-07482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Metacarpal shaft fracture is a common type of hand fracture. Numerous studies have explored fixing transverse fractures in the midshaft of the metacarpal bone. However, this section of the metacarpal bone is often susceptible to high-energy injury, resulting in comminuted fracture or bone loss. In such cases, wedge-shaped bone defects can develop in the metacarpal shaft, increasing the difficulty of performing fracture fixation. Notably, the research on this type of fracture fixation is limited. This study compared the abilities of four fixation methods to fix metacarpal shaft fractures with wedge-shaped bone defects. METHODS In total, 28 artificial metacarpal bones were used. To create wedge-shaped bone defects, an electric saw was used to create metacarpal shaft fractures at the midshaft of each bone. The artificial metacarpal bones were then divided into four groups for fixation. The bones in the first group were fixed with a dorsal locked plate (DP group), those in the second group were fixed with a volar locked plate (VP group), and those in the third group were fixed by combining dorsal and volar locked plates (DP + VP group), and those in the fourth group were fixed with two K-wires (2 K group). Cantilever bending tests were conducted using a material testing machine to measure yielding force and stiffness. The four groups' fixation capabilities were then assessed through analysis of variance and Tukey's test. RESULTS The DP + VP group (164.1±44.0 N) achieved a significantly higher yielding force relative to the 2 K group (50.7 ± 8.9 N); the DP group (13.6 ± 3.0 N) and VP group (12.3 ± 1.0 N) did not differ significantly in terms of yielding force, with both achieving lower yielding forces relative to the DP + VP group and 2 K group. The DP + VP group (19.8±6.3 N/mm) achieved the highest level of stiffness, and the other three groups did not differ significantly in terms of stiffness (2 K group, 5.4 ± 1.1 N/mm; DP group, 4.0 ± 0.9 N/mm; VP group, 3.9 ± 1.9 N/mm). CONCLUSIONS The fixation method involving the combined use of dorsal and volar locked plates (DP + VP group) resulted in optimal outcomes with respect to fixing metacarpal shaft fractures with volar wedge bone defects.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Chen-Wei Yeh
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, China Medical University, Taichung, 404, Taiwan.
- School of Dentistry, China Medical University, Taichung, 404, Taiwan.
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Kwan SA, Wang WL, Tulipan JE, Kachooei A, Beredjiklian PK, Rivlin M. Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study. J Wrist Surg 2024; 13:54-57. [PMID: 38264131 PMCID: PMC10803140 DOI: 10.1055/s-0042-1758705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
Background Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.
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Affiliation(s)
- Stephanie A. Kwan
- Department of Orthopaedic Surgery, Rowan University SOM, Stratford, New Jersey
| | - William L. Wang
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jacob E. Tulipan
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Amir Kachooei
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | | | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Thomas TL, Muchintala R, Crutchfield CR, Plusch K, Jones CM, Ilyas AM. Outcomes Following Fully Threaded Intramedullary Nailing of Metacarpal Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:85-90. [PMID: 38313619 PMCID: PMC10837302 DOI: 10.1016/j.jhsg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/14/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Intramedullary screw fixation has emerged as a popular approach for the treatment of displaced metacarpal fractures. The purpose of this study was to investigate the functional and radiographic outcomes of a newly designed, headless noncompressive fully threaded intramedullary nail (TIMN) for the treatment of metacarpal fractures. Methods A retrospective chart review was performed on patients who were treated with the INnate TIMN (ExsoMed) at a single academic institution with a minimum of 1-year follow-up. Patient-reported functional outcomes included Quick Disabilities for the Arm, Shoulder, and Hand (QuickDASH) questionnaires, return to work and physical activity time, and overall satisfaction. Radiographs were retrospectively reviewed to determine radiographic union, change in angulation, and metacarpal shortening. Results A total of 49 patients (58 fractures) with a mean age of 36 years (range: 17-75 years) were included. The mean follow-up time was 2.7 years (range: 1.4-4.3 years). Overall, the mean patient satisfaction rating was 4.9 of 5 (range: 3-5). The mean return to work time was 7.2 weeks (range: 0.14-28 weeks), and the mean return to sport or activity was 8.3 weeks (range: 1-28 weeks). Average QuickDASH scores across all patients were 4 (range: 0-56.9). The median radiographic healing time was 6.1 weeks (range: 4.7-15.4 weeks). Mean postoperative shortening in the fifth metacarpal fracture was 3 mm (range: -4.2 to 8 mm) at the initial postoperative visit and 3.6 mm (range: -3.3 to 7.9 mm) at the final radiographic follow-up. Subgroup analysis showed that postoperative shortening was similar, regardless of the fracture pattern. The following four complications were reported: one case of persistent pain and stiffness, one case of carpal tunnel syndrome, one nonunion, and one fractured intramedullary nail. Conclusions Our findings suggest that the TIMN allows for a reliable return to work and physical activity, high patient satisfaction, low complication rate, and minimal shortening at the final radiographic follow-up. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | - Rahul Muchintala
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Kyle Plusch
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Asif M. Ilyas
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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7
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Thomas TL, Kachooei AR, Ilyas AM. Intramedullary K-wires versus Alternate Techniques for Metacarpal Shaft and Neck Fractures: A Systematic Review and Meta-analysis. J Hand Microsurg 2023; 15:376-387. [PMID: 38152671 PMCID: PMC10751204 DOI: 10.1055/s-0042-1749410] [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: 10/17/2022] Open
Abstract
Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/ quick DASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time ( p = 0.04; mean difference = - 13; 95% confidence interval = -26 to -0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.
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Affiliation(s)
- Terence L. Thomas
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Amir R. Kachooei
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
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8
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Graf AR, Ahmed AS, Thompson D, Wagner E, Gottschalk M, Suh N, Seiler JG. Intramedullary Metacarpal Fracture Fixation: A Biomechanical Study of Screw Diameter and Comparison With Intramedullary Wire Stabilization. J Hand Surg Am 2023:S0363-5023(23)00067-9. [PMID: 36914453 DOI: 10.1016/j.jhsa.2023.01.026] [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: 09/05/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Interest in intramedullary metacarpal fracture fixation (IMFF) with screws is increasing. However, the optimal screw diameter for fracture fixation is not yet established. In theory, larger screws should be more stable, but there is concern about long-term sequelae of larger metacarpal head defects and extensor mechanism injury created during insertion as well as implant cost. Therefore, the purpose of this study was to compare different diameter screws for IMFF to a popular and more cost-effective alternative of intramedullary wiring. METHODS Thirty-two cadaveric metacarpals were used in a transverse metacarpal shaft fracture model. Treatment groups consisted of IMFF with 3.0 × 60 mm, 3.5 x 60 mm, and 4.5 x 60 mm screws as well as 4 1.1-mm intramedullary wires. Cyclic cantilever bending was performed with the metacarpals mounted at 45° to simulate physiologic loading. Cyclical loading at 10, 20, and 30 N was performed to determine fracture displacement, stiffness, and ultimate force. RESULTS At 10, 20, and 30 N of cyclical loading, all screw diameters tested provided similar stability as measured by fracture displacement and were superior to the wire group. However, ultimate force under load to failure testing was similar between the 3.5- and 4.5-mm screws and superior to 3.0-mm screws and wires. CONCLUSIONS For IMFF, 3.0, 3.5, and 4.5-mm diameter screws provide adequate stability for early active motion and are superior to wires. When comparing the different screw diameters, 3.5- and 4.5-mm diameter screws offer similar construct stability and strength superior to the 3.0-mm diameter screw. Therefore, to minimize metacarpal head morbidity, smaller screw diameters may be preferable. CLINICAL RELEVANCE This study suggests that IMFF with screws is biomechanically superior to wires in cantilever bending strength in the transverse fracture model. However, smaller screws may be sufficient to permit early active motion while minimizing metacarpal head morbidity.
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Affiliation(s)
- Alexander R Graf
- Emory University, Department of Orthopedic Surgery, Atlanta, GA.
| | - Adil S Ahmed
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | - Dan Thompson
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | - Eric Wagner
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
| | | | - Nina Suh
- Emory University, Department of Orthopedic Surgery, Atlanta, GA
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9
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Huang CH, Lo IN, Wang JP. The Addition of a Temporary Intramedullary K-wire to Facilitate Plating for Metacarpal Fractures. Tech Hand Up Extrem Surg 2023; 27:45-48. [PMID: 35993564 DOI: 10.1097/bth.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Open reduction internal fixation with plate fixation is commonly used in treating metacarpal fractures to facilitate early rehabilitation. However, it is sometimes challenging to maintain a satisfactory 3-dimensional alignment during the plating process. We present a method using a temporary centrally placed intramedullary k-wire to maintain a fundamental stability for reduction of metacarpal fractures. This method facilitates the plating process and simplifies the open reduction internal fixation of the metacarpal fractures.
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Affiliation(s)
- Chi-Han Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Ning Lo
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopaedics, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, National Yang Ming Chiao Tung University, Taipei, Taiwan
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10
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Bhashyam AR, Mudgal C. Intramedullary Headless Screw Fixation for Metacarpal Fractures - Technical Tips. J Hand Surg Asian Pac Vol 2023; 28:144-148. [PMID: 36866824 DOI: 10.1142/s2424835523710017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Metacarpal fractures are a common injury in the hand. When surgical intervention is indicated, there are multiple approaches and techniques of fixation. Intramedullary fixation has become an increasingly versatile method of fixation. The limited dissection needed for its insertion, rotational stability provided by the isthmic fit and lack of requisite hardware removal are improvements over conventional K-wire or plate fixation techniques. Multiple outcome studies have confirmed its safety and effectiveness. In this technical note, we provide some tips that can help surgeons considering intramedullary headless screw fixation of metacarpal fractures. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Abhiram R Bhashyam
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chaitanya Mudgal
- Hand & Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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11
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Chiu YC, Hsu CE, Ho TY, Ting YN, Tsai MT, Hsu JT. Biomechanical study on fixation methods for horizontal oblique metacarpal shaft fractures. J Orthop Surg Res 2022; 17:374. [PMID: 35922799 PMCID: PMC9351190 DOI: 10.1186/s13018-022-03267-2] [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: 06/03/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft fractures. MATERIALS AND METHODS Horizontal oblique metacarpal shaft fractures were created in 21 artificial metacarpal bones and fixed using one of the three methods: (1) two lag screws, (2) a regular plate, and (3) a locking plate. All the specimens were subjected to the cantilever bending test performed using a material testing machine to enable recording of the force-displacement data of the specimens before failure. The Kruskal-Wallis test was used to compare failure force and stiffness values among the three fixation methods. RESULTS The mean failure force of the two lag screw group (78.5 ± 6.6 N, mean + SD) was higher than those of the regular plate group (69.3 ± 17.6 N) and locking plate group (68.2 ± 14.2 N). However, the mean failure force did not significantly differ among the three groups. The mean stiffness value of the two lag screw group (17.8 ± 2.6 N/mm) was lower than those of the regular plate group (20.2 ± 10.5 N/mm) and locking plate group (21.8 ± 3.8 N/mm). However, the mean stiffness value did not significantly differ among the three groups. CONCLUSION The fixation strength of two lag screw fixation did not significantly differ from that of regular and locking bone plate fixation, as indicated by the measurement of the ability to sustain force and stiffness.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, College of Biomedical Engineering, China Medical University, Taichung, 404, Taiwan. .,School of Dentistry, College of Dentistry, China Medical University, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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12
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Chiu YC, Ho TY, Hsu CE, Ting YN, Tsai MT, Hsu JT. Comparison of the fixation ability between lag screw and bone plate for oblique metacarpal shaft fracture. J Orthop Surg Res 2022; 17:72. [PMID: 35123532 PMCID: PMC8817463 DOI: 10.1186/s13018-022-02963-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
For oblique metacarpal shaft fracture, if anatomical reduction is achieved through conservative cast immobilization rather than stable fixation, bone malrotation can easily occur, resulting in severe loss in hand prehensile function. However, whether bone plate fixation or only lag screw fixation is more preferable remains unclear. Few studies have evaluated whether screw fixation can provide biomechanical fixation strength similar to bone plate fixation.
Objective
We assessed the difference in fixation strength between fixtation with two lag screws and bone plate for oblique metacarpal shaft fractures.
Materials and methods
We created oblique metacarpal shaft fractures on 21 artificial bones and fixated them using (1) double lag screw (2LS group), (2) regular plate (RP group), or (3) locked plate (LP group). To obtain the force–displacement data, a cantilever bending test was conducted for each specimen through a material testing machine. One-way analysis of variance and a Tukey test were conducted to compare the maximum fracture force and stiffness of the three fixation methods.
Results
The maximum fracture force of the 2LS group (mean + SD: 153.6 ± 26.5 N) was significantly lower than that of the RP (211.6 ± 18.5 N) and LP (227.5 ± 10.0 N) groups (p < 0.001). However, no significant differences were discovered between the RP and LP groups. The coefficient of variation for the maximum fracture force of the 2LS group (17.3%) was more than twice as high as that of the RP (8.7%) and LP (4.4%) groups. In addition, the stiffness of the three fixation methods was similar.
Conclusion
Compared with bone plate fixation, double lag screw fixation yielded slightly lower maximum bearable fracture force but similar stiffness. Therefore, this technique could be used for treating oblique metacarpal shaft fractures. However, using double lag screw fixation alone is technically demanding and requires considerable surgical experiences to produce consistent results.
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