Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications

OUTCOMES OF FIXATION METACARPAL FRACTURES USING BIOABSORBABLE IMPLANTS

Introduction. Tactics of treatment of fractures of the metacarpal bones are sufficiently covered in domestic and foreign literature, however, the search for modern methods of the most effective fixation of fractures of the hand bones is still ongoing. The fixator should ensure the stability of bone fragments, have sufficient strength and undergo biodegradation after fusion, eliminate the need for repeated surgery. Purpose of the study: to evaluate results of fixation of 2-5 metacarpal fractures using bioabsorbable implants.

Materials and methods: there was a retrospective study of 40 patients who had displaced closed fractures of 2-5 metacarpal bones. We performed surgical treatment: open reduction of the metacarpal fracture and internal fixation with bioabsorbable implants (Bioretec Activa Pin). Patients were examined before, 3 and 12 months after surgery.

Results: All patients had union of metacarpal fracture 3 months after surgery. The function of the hand has improved, when evaluated on the DASH scale from 62 to 9.2 (p≤0.05). The pain level (VAS) was significantly decreased from 72 to 13.5 (p≤0.05). All parameters were comparable by 12 months after surgery.

Conclusions: bioabsorbable implants are reliable way for internal fixation of fractures of 2-5 metacarpal bones with displaced fragments. Method is no need to remove the fixator.

Percutaneous reduction and fixation technique for 4th metacarpal shaft fracture

The objective of this retrospective study was to introduce a percutaneous reduction and intermetacarpal K-wire fixation technique for the treatment of the 4th metacarpal shaft fracture. From January 2014 to February 2017, 25 patients with isolated closed 4th metacarpal shaft fracture (angulation > 30°, rotation > 5°, or shortening > 5 mm) were treated by percutaneous reduction and internal fixation. Assessment comprised total active motion, grip strength, dorsal prominence, and patient satisfaction. Bone healing was achieved in all patients. At a mean follow-up of 28 months (range, 25-32 months), total active range of motion averaged 98% of contralateral values (range, 88%-100%). There were 20 excellent and 5 good results. Grip strength averaged 97% of contralateral values (range, 88%-100%). Mean dorsal prominence on a 100-mm visual analogue scale was 0 (range, 0-1). Mean satisfaction rating on the Short Assessment of Patient Satisfaction 26 (range, 22-28). Percutaneous reduction and intermetacarpal K-wire fixation is a useful technique for treating 4th metacarpal shaft fracture, achieving stable and reliable fixation, with good hand function.