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Mortada H, AlNojaidi TF, Bhatt G, Bafail A, Koorapaty P, Alsanad LA, Almehaid F, Alrobaiea S, Alalola R, Kattan AE. Evaluating Kirschner wire fixation versus titanium plating and screws for unstable phalangeal fractures: A systematic review and meta-analysis of postoperative outcomes. J Hand Microsurg 2024; 16:100055. [PMID: 39035864 PMCID: PMC11257138 DOI: 10.1016/j.jham.2024.100055] [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: 07/23/2024] Open
Abstract
Background Unstable phalangeal fractures represent a clinical challenge in hand surgery. The choice of fixation method, whether Kirschner wire (K-wire) fixation or titanium plating with screws, often depends on surgeon preference due to the lack of comprehensive comparative data. This article aimed to compare the postoperative outcomes of K-wire fixation versus titanium plating and screws in the treatment of unstable phalangeal fractures. Methods This review was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. A systematic review and meta-analysis of the existing literature was done encompassing PUBMED, EMBASE, Google Scholar, and Cochrane library using the keywords: "K wire/ Kirschner wire", "titanium plate/ screws", "Miniplate/ screws", and "Unstable phalan∗ fracture/ hand fracture". Results After screening 2374 articles, 6 final studies with a total of 414 patients were included. Operative time was significantly shorter with K-wire fixation compared to plating, by a mean difference of -27.03 min [95% CI -43.80, -10.26] (p = 0.02). Time to radiographic union averaged 7.43 weeks with K-wires versus 8.21 weeks with titanium plates. No statistically significant differences emerged between groups for overall complications (p = 0.69), infection (p = 0.47), malunion (p = 0.36), stiffness (p = 0.11), or need for reoperation (p = 0.10). Conclusion K-wire fixation demonstrated shorter mean operating time and faster radiographic union versus plating for unstable phalangeal fractures. These findings can guide surgical decisions and emphasize the need for individualized treatment based on fracture type and patient factors.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Taif Fawaz AlNojaidi
- Department of Plastic and Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gaurang Bhatt
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Anas Bafail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Piyush Koorapaty
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | | | - Faisal Almehaid
- Department of Plastic and Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saad Alrobaiea
- Department of Plastic Surgery and Burn Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Rayan Alalola
- Department of Plastic Surgery, Security Forces hospital, Riyadh, Saudi Arabia
| | - Abdullah E. Kattan
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Pintore A, Astone A, Vecchio G, Asparago G, Calabrò G, Migliorini F, Maffulli N. Percutaneous transverse pinning for metacarpal fractures: a clinical trial. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05422-2. [PMID: 38965077 DOI: 10.1007/s00402-024-05422-2] [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: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Alberto Astone
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giampiero Calabrò
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England, UK.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, England, E1 4DG, UK.
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy.
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Del Chiaro A, Suardi C, Nucci AM, Grassi A, Pfanner S, Poggetti A. Choosing the proper implant for extra-articular fractures of proximal phalanges: A study on 75 cases. Injury 2024; 55:111441. [PMID: 38430751 DOI: 10.1016/j.injury.2024.111441] [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: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Phalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. MATERIAL AND METHODS We compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). RESULTS We found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DISCUSSION The surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. CONCLUSIONS In conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.
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Affiliation(s)
- A Del Chiaro
- 1st Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, Pisa, IT, Italy
| | - Chiara Suardi
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy.
| | - A M Nucci
- Paediatric Orthopaedic and Traumatology Department, Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - A Grassi
- 2nd Orthopaedic and Trauma Unit, IRCCS (Istituto Ortopedico Rizzoli), Via Di Barbiano, 1/10, Bologna, IT, Italy
| | - S Pfanner
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
| | - A Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
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Abbot H, George AR, McCarron L, Graham DJ, Sivakumar B. Intramedullary Screw Fixation of Proximal Phalangeal Fractures: Short- to Medium-term Outcomes. Hand (N Y) 2024:15589447241235339. [PMID: 38491777 DOI: 10.1177/15589447241235339] [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] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intramedullary screw fixation of phalangeal and metacarpal fractures has gained popularity as a method of providing rigid internal fixation with minimum tendon disturbance, allowing early mobilization and rehabilitation. Despite this, the literature on outcomes using this technique is limited. Thus, the aim of this study was to assess the short-term to medium-term outcomes of intramedullary screw fixation for proximal phalangeal fracture fixation in an Australian setting. METHODS A retrospective analysis of consecutive patients with a fracture(s) of the proximal phalanx fixated using intramedullary screws between January 2020 and March 2023 was conducted via telehealth. RESULTS Forty-six phalangeal fractures from 37 patients were included in this study. Mean Quick Disabilities of the Arm, Shoulder, and Hand score of 6.2 (range: 0-61.4, median: 0), mean pain visual analogue scale score of 1.8 (range: 1-7, median: 1), and mean total active motion of 231° (range: 132-282) were noted. A total of 4.4% of fractures sustained a major complication, and 94.6% of patients reported willingness to undergo intramedullary screw fixation again. CONCLUSION This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. Superior clinical outcomes, as well as cost-effectiveness and time-effectiveness, render it a viable alternative to plate fixation in this setting.
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Affiliation(s)
- Hagen Abbot
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adam R George
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Herston, Australia
| | - Brahman Sivakumar
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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Popa Ș, Ciongradi CI, Sârbu I, Bîcă O, Popa IP, Bulgaru-Iliescu D. Traffic Accidents in Children and Adolescents: A Complex Orthopedic and Medico-Legal Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1446. [PMID: 37761407 PMCID: PMC10527870 DOI: 10.3390/children10091446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Traffic accidents involving children and adolescents present complex challenges from both the medico-legal and orthopedic standpoints. Despite the implementation of road traffic safety laws, pediatric road traffic injuries continue to be a significant contributor to mortality rates, physical harm, and hospitalization on a global scale. For children and young people, automobile accidents are considered to be the primary culprit of mortality in developed nations. Even in highly developed nations, trauma is a significant factor in infant mortality. Each age category, from childhood to young adulthood, has its fracture patterns, as their skeletons are considerably different from those of adults. The consequences of traffic accidents extend beyond the immediate physical trauma. The medico-legal aspects surrounding these incidents add another layer of complexity, as legal repercussions may affect the responsible adult or parent, particularly in cases involving child fatalities. To effectively address traffic accidents in children and adolescents, a comprehensive approach is necessary. This approach should involve not only medical professionals but also legal experts and policymakers. Collaboration between orthopedic specialists, medico-legal professionals, law enforcement agencies, and relevant government bodies can facilitate the development and implementation of strategies aimed at prevention, education, the enforcement of traffic laws, and improved infrastructure. By addressing both the medical and legal aspects, it is possible to enhance road safety for children and adolescents, reducing the incidence of injuries and their associated long-term consequences. In this review, we aimed to summarize traffic accidents in children and adolescents from a complex orthopedic and medico-legal approach.
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Affiliation(s)
- Ștefan Popa
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Carmen Iulia Ciongradi
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ioan Sârbu
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Ovidiu Bîcă
- 2nd Department of Surgery–Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (Ș.P.); (I.S.); (O.B.)
| | - Irene Paula Popa
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Diana Bulgaru-Iliescu
- 3rd Department of Medical Specialities–Legal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
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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.
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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.
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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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Seaton D, Sidhu G, Kitsis C, Ashwood N. Open Reduction and External Fixation of a Comminuted Intra-articular Fifth Metacarpal Head Fracture: A Case Report. Cureus 2023; 15:e38845. [PMID: 37303336 PMCID: PMC10255934 DOI: 10.7759/cureus.38845] [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: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Comminuted intra-articular fractures are among the most difficult to fix, with open reduction and internal fixation often being impossible. We report the case of a 15-year-old male who required an open reduction with external fixation after sustaining an extremely comminuted intra-articular fifth metacarpal head fracture of the right hand. The patient presented with swelling localised to the fourth and fifth dorsal metacarpals of the right hand, with radiographs demonstrating an intra-articular fracture with comminution and articular surface depression. Literature surrounding metacarpal head fractures, although scarce, suggests that whilst treatment must be individualised, most osteochondral fractures can be managed via open reduction with internal fixation either via K wires, interfragmentary screws or small headless screws. This case demonstrates that in challenging cases, with limited bone stock and cavities created through reduction of the fracture, fixation can be achieved through K wire with HK2 external fixation. It also highlights the apparent insufficiency in articles specifically detailing potential management options for intra-articular metacarpal fractures and has provided evidence of one potential fixation method.
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Affiliation(s)
- David Seaton
- Trauma and Orthopaedics, University of Leicester Medical School, Leicester, GBR
| | - Gur Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Christos Kitsis
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, Wolverhampton University Research Institute, Wolverhampton, GBR
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Dohse NM, Jones CM, Ilyas AM. Fixation of Hand Fractures with Intramedullary Headless Compression Screws. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:1004-1012. [PMID: 36721649 PMCID: PMC9846723 DOI: 10.22038/abjs.2022.64506.3102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/28/2022] [Indexed: 02/02/2023]
Abstract
Metacarpal and phalangeal fractures remain among the most frequently encountered orthopedic injuries, accounting for 10% of all fractures. For operative fractures, there is an array of treatment options with percutaneous kirschner wire stabilization and screw and plate fixation strategies predominating. Recently, a new fixation method was introduced, intramedullary (IM) fixation with headless screws, which has advantages of a percutaneous technique and buried hardware. The purpose of this review is to highlight the indications and surgical techniques of IM screw fixation of metacarpal and phalangeal fractures. Although more research is needed, IM fixation represents a potentially reliable alternative to Kirschner-wire and plate fixation.
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Affiliation(s)
- Nicolas M. Dohse
- Department of Orthopaedic Surgery, University of Florida Jacksonville Florida, USA
| | - Christopher M. Jones
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Asif M. Ilyas
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Sivakumar BS, An VVG, Graham DJ, Ledgard J, Lawson RD, Furniss D. Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review. Hand (N Y) 2022; 17:595-601. [PMID: 32988227 PMCID: PMC9274898 DOI: 10.1177/1558944720928503] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.
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Affiliation(s)
- Brahman S. Sivakumar
- Royal North Shore Hospital, St Leonards, NSW, Australia,Brahman S. Sivakumar, Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
| | | | | | - James Ledgard
- Royal North Shore Hospital, St Leonards, NSW, Australia
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Biehl C, Stötzel S, Schock L, Szalay G, Heiss C. Treatment of hand and finger fractures with the Stryker Hand Plating System. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc03. [PMID: 35465637 PMCID: PMC9006317 DOI: 10.3205/000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/01/2021] [Indexed: 11/18/2022]
Abstract
Objectives: 10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System. Patients and methods: Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters. Results: Three-quarters of the patients were male. The mean age at the time of surgery was 39.3±16 years. Falling was the leading cause for hand fractures, and the most common were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. Conclusion: The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. Level of Evidence: Level: IV; outcome-study, retrospective.
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Affiliation(s)
- Christoph Biehl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany,*To whom correspondence should be addressed: Christoph Biehl, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Rudolf-Buchheim-Str. 7, 35392 Gießen, Germany, E-mail:
| | - Sabine Stötzel
- Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Lydia Schock
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Gabor Szalay
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Gießen, Germany,Experimental Trauma Surgery, Justus Liebig University of Gießen, Germany
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12
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Fan A, Zhang X, Zhang X, Zhang L, Peng A, Yu X. Treatment of isolated fourth metacarpal neck fractures using the closed reduction and percutaneous intermetacarpal and external fixation. J Orthop Sci 2022; 28:637-644. [PMID: 35246359 DOI: 10.1016/j.jos.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The isolated fourth metacarpal neck fracture is uncommon, and the appropriate management is still debatable. The aim of this retrospective study was to introduce a closed reduction and percutaneously intermetacarpal K-wire fixation external technique to treat the isolated fourth metacarpal neck fracture. METHODS From October 2013 to January 2018, 21 patients with closed-isolated fourth metacarpal neck fractures (angulation ≥35°, rotation ≥5°, or shortening ≥5 mm) were treated with the closed reduction and percutaneous intermetacarpal and external fixation technique. Total active motion, grip strength of the hand, dorsal prominence, and patient satisfaction were assessed. RESULTS Follow-up lasted 28 months (range, 24-37 months). All patients obtained bone healing at a mean time of 5 weeks (range, 4-8 weeks). External fixation devices were removed when bone healing achieved. The mean total active motion reached 97.5% (range, 92.9%-100%) of opposite side. There were 18 excellent and 3 good results. The mean grip strength reached 98.4% (range, 96.2%-100%) of the opposite hands. Based on the 100-mm visual analogue scale, the mean dorsal prominence was 0 (range, 0 to 1). Based on the Short Assessment of Patient Satisfaction, the mean satisfaction score was 26 (range, 24 to 28). CONCLUSIONS The closed reduction and percutaneous intermetacarpal and external fixation technique is useful and reliable for treating the isolated fourth metacarpal neck fracture. The technique can effectively restore the fracture deformities and maintain the reduction stably, resulting in good hand function. LEVEL OF EVIDENCE Therapeutic study, Level IV.
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Affiliation(s)
- Anwei Fan
- Department of Orthopaedic, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, 054000, China.
| | - Xiao Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Xu Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Lu Zhang
- Department of Orthopaedic, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, 054000, China.
| | - Aqin Peng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| | - Xuanrong Yu
- Department of Orthopaedic, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, 054000, China.
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13
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Kreutz-Rodrigues L, Gibreel W, Moran SL, Carlsen BT, Bakri K. Frequency, Pattern, and Treatment of Hand Fractures in Children and Adolescents: A 27-Year Review of 4356 Pediatric Hand Fractures. Hand (N Y) 2022; 17:92-97. [PMID: 32036680 PMCID: PMC8721808 DOI: 10.1177/1558944719900565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The frequency, pattern, and treatment of pediatric hand fractures are rarely reported. We sought to review our institution's experience in the management of pediatric hand fractures. Methods: A retrospective review of children and adolescents (younger than 18 years) treated for hand fractures between January 1990 and June 2017 was preformed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, or intra-articular metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) fractures. Patients were categorized into 3 age groups (0-5, 6-11, and 12-17 years). Results: A total of 4356 patients were treated for hand fractures at a mean ± SD age of 12.2 ± 3.5 years. Most fractures occurred in patients aged 12 to 17 years (n = 2775, 64%), followed by patients aged 6 to 11 years (n = 1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the proximal/middle phalanx (48%), followed by metacarpal (33%), distal phalangeal (12%), and intra-articular MCP/PIP/DIP joints (7%). Proximal/middle phalangeal fractures were the most common in all age groups. About 58% of intra-articular MCP/PIP/DIP fractures in patients aged between 0 and 5 years required open reduction ± fixation, and the remaining 42% fractures were amenable to closed reduction. In patients older than 5 years, about 70% of these fractures were amenable to closed reduction. All age groups included, most metacarpal (93%), proximal/middle phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed reduction alone. Conclusions: The frequency, pattern, and treatment of hand fractures vary among different age groups. Understanding the pattern of these fractures helps making the right diagnosis and guides choosing the appropriate treatment.
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Affiliation(s)
| | | | | | | | - Karim Bakri
- Mayo Clinic, Rochester, MN, USA,Karim Bakri, Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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14
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Aita MA, Oliveira RKD, Biondi BG, Brunelli JPF, Ruggiero GM, Delgado PJ. Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study. Rev Bras Ortop 2021; 56:717-725. [PMID: 34900099 PMCID: PMC8651448 DOI: 10.1055/s-0041-1729568] [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: 04/26/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objeticve
To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week.
Methods
This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (
n
= 20) or bouquet (2 or 3 Kirschner wires) (
n
= 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months.
Results
At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group.
Conclusions
In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.
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Affiliation(s)
- Marcio Aurelio Aita
- Departamento de Cirurgia da Mão, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | - Bruno Gianordoli Biondi
- Divisão de Cirurgia da Mão e Microcirurgia, Departamento de Cirurgia - Ortopedia e Trauma, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | | | - Pedro Jose Delgado
- Unidade de Cirurgia De Mão, Hospital Universitario Madrid Montepr Príncipe, CEU San Pablo University, Boadilla del Monte, Madrid, Espanha
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15
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Then JW, Shivdas S, Tunku Ahmad Yahaya TS, Ab Razak NI, Choo PT. Gamification in rehabilitation of metacarpal fracture using cost-effective end-user device: A randomized controlled trial. J Hand Ther 2021; 33:235-242. [PMID: 32430167 DOI: 10.1016/j.jht.2020.03.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/21/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a two-group randomized controlled trial. INTRODUCTION Finger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies. PURPOSE OF THE STUDY The purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures. METHODS A 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance. RESULTS There were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P < .05). No adverse events were reported. DISCUSSION Our results suggest that gamification using a cost-effective device demonstrated similar effectiveness as conventional physiotherapy in post-metacarpal fracture rehabilitation. CONCLUSIONS Gamification using a mobile device is an inexpensive and safe alternative to conventional physiotherapy for hand rehabilitation after metacarpal fractures. It effectively serves as a guide for future development of cost-effective technology-enhanced therapy.
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Affiliation(s)
- Jun Wei Then
- Faculty of Medicine, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, Kuala Lumpur, Malaysia.
| | - Sachin Shivdas
- Upper Limb & Reconstructive Microsurgery Unit, Faculty of Medicine, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, Kuala Lumpur, Malaysia
| | - Tunku Sara Tunku Ahmad Yahaya
- Upper Limb & Reconstructive Microsurgery Unit, Faculty of Medicine, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, Kuala Lumpur, Malaysia
| | - Nor Izzati Ab Razak
- Upper Limb & Reconstructive Microsurgery Unit, Faculty of Medicine, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, Kuala Lumpur, Malaysia
| | - Pee Terh Choo
- Department of Orthopaedic Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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16
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Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument. Arch Plast Surg 2021; 48:384-388. [PMID: 34352949 PMCID: PMC8342248 DOI: 10.5999/aps.2021.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
Adequate positioning of the hand is a critical step in hand fracture operative repair that can impact both the clinical outcome and the efficiency of the operation. In this paper, we introduce the use of a thermoplastic splint with an added thumb stabilizing component as a means to increase the surgeon’s autonomy and to streamline the patient care pathway. The thermoplastic splint is custom fabricated preoperatively by the specialist hand therapist. The splint is used prior, during, and post operation with minimal modification. The thumb component assists maintaining the forearm in a stable pronated position whilst drilling and affixing metal work. This is demonstrated in the video of removal of metal work and open reduction and internal fixation of a metacarpal fracture.
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17
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Baydar M, Aydın A, Şencan A, Orman O, Aykut S, Öztürk K. Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures. Jt Dis Relat Surg 2021; 32:397-405. [PMID: 34145817 PMCID: PMC8343844 DOI: 10.52312/jdrs.2021.40] [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: 02/19/2021] [Accepted: 04/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In this study, we aimed to compare clinical and radiographic outcomes of retrograde intramedullary Kirschner-wire (K-wire) fixation with those of plate-screw (PS) fixation. PATIENTS AND METHODS A total of 98 metacarpal shaft fractures in 75 patients (65 males, 10 females; mean age: 31.2±10.9 years; range, 16 to 65 years) were included between January 2011 and December 2017. The total joint active range of motion (AROM) and grip strength of the healthy and broken hands were evaluated. The Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded. We compared surgery duration, number of fluoroscopy images, and cost-effectiveness for each technique. RESULTS The overall mean follow-up was 21.9 (range, 12 to 56) months. At the last follow-up, total joint AROM (p=0.072), VAS score (p=0.298), QuickDASH score (p=0.132), and hand grip strength (p=0.947) were similar between the groups. Radiological union occurred in the PS and K-wire groups in a mean of 5.84 (range, 3 to 8) and 4.46 (range, 3 to 20) weeks, respectively (p=0.173). A significant difference was found in surgery duration (p=0.021) and number of fluoroscopy images (p<0.05) between the PS and K-wire groups. Two wound complications were observed in the PS group and one with K-wires. CONCLUSION Retrograde intramedullary K-wire fixation has certain advantages such as being less invasive and more accessible with shorter operation time, compared to PS fixation. Similar radiological and clinical scores can be obtained in patients undergoing retrograde intramedullary K-wire fixation or PS fixation.
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Affiliation(s)
- Mehmet Baydar
- Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi, El Cerrahisi Bölümü, 34470 Sarıyer, İstanbul, Türkiye
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18
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Hussain MH, Ghaffar A, Choudry Q, Iqbal Z, Khan MN. Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review. Cureus 2020; 12:e9442. [PMID: 32864266 PMCID: PMC7451089 DOI: 10.7759/cureus.9442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Boxer’s fracture is the fifth metacarpal neck fracture resulting from direct trauma to the clenched fist. Worldwide, this type of fracture is the most typical presentation to emergency departments. The management of fifth metacarpal fractures varies from one setting to another. Conservative management is the preferred option for closed, non-angulated, non-malrotated fractures while open fractures, significant angulation, rotational deformity, and intra-articular extension are recognised indications for surgical intervention. The scope of this article covers the results of a literature review examining the management strategies for such fractures.
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Affiliation(s)
| | - Ali Ghaffar
- Orthopaedics and Trauma, East Lancashire NHS Hospitals, Blackburn, GBR
| | - Qaisar Choudry
- Orthopaedics and Trauma, East Lancashire NHS Hospitals, Blackburn, GBR
| | - Zafar Iqbal
- Emergency Medicine, California Institute of Behavioural Neurosciences and Psychology, Fairfield, USA.,Emergency Department, The Kidney Center, Karachi, PAK
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19
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Labèr R, Jann D, Behm P, Ferguson SJ, Frueh FS, Calcagni M. Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study. J Hand Surg Eur Vol 2020; 45:595-600. [PMID: 31948331 DOI: 10.1177/1753193419898066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intramedullary cannulated compression screws have been introduced for the fixation of unstable metacarpal fractures. In the present study, this technique was compared with dorsal compression plating to evaluate its biomechanical performance in stabilizing metacarpal shaft fractures. In a first set of experiments, the biomechanical characteristics of the screws were analysed in an artificial bone model. In subsequent experiments, midshaft osteotomies were performed in human cadaver metacarpals, followed by plating or intramedullary screw osteosynthesis. The metacarpals were tested to failure in cantilever bending, following a stepwise increasing cyclic loading protocol. We found a significantly lower load at failure and a significantly lower number of cycles to failure in the intramedullary screw group, but both methods offered sufficient stability under these loads. With reference to published loads on the metacarpals during use of the hand, we conclude that intramedullary osteosynthesis yields sufficient strength and stiffness for early active motion. A difference in its fixation stability is noted compared with plate fixation, which may not be clinically relevant.
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Affiliation(s)
- Raffael Labèr
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - David Jann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Florian S Frueh
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
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20
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Patient-Reported Outcomes and Complications After Surgical Fixation of 143 Proximal Phalanx Fractures. J Hand Surg Am 2020; 45:327-334. [PMID: 31585743 DOI: 10.1016/j.jhsa.2019.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/11/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple methods exist to surgically fix unstable phalangeal fractures. Whereas these methods have different rates of complications or reoperation, it is not known whether these differences lead to changes in patient reported outcome. We compared patient-reported outcomes measures and complications of Kirschner wire (K-wire), lag-screw and plate fixation of proximal phalanx fractures (excluding the thumb). METHODS From 2010 to 2015, 159 patients with 159 proximal phalanx fractures were identified in 2 level 2 trauma centers and fixed with K-wires (44% of patients), lag-screws (26%), or plates (30%). Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) and complications were assessed. In addition, subjective outcomes were assessed. Follow-up was achieved for 143 fractures (90%) and average time to follow-up was 3.4 years. RESULTS Mean DASH and PRWHE scores were 5.0 and 8.2, respectively. No differences in functional outcomes were found between fixation methods, although unplanned reoperation was more common in the plate fixation group (9 patients; 21%) than in the K-wire and lag-screw fixation groups (3 patients and 1 patient; 4.8 and 2.7%, respectively). We also found that K-wire fixation was associated with better aesthetic outcome than open reduction internal fixation. CONCLUSIONS Overall patient-reported outcomes measure scores were similar across fixation methods, and unplanned reoperation was more prevalent after plate fixation. In addition, we found that regardless of fracture pattern, percutaneous fixation with K-wires was often sufficient and associated with better aesthetic outcome than open reduction and internal fixation. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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21
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Crowe CS, Massenburg BB, Morrison SD, Chang J, Friedrich JB, Abady GG, Alahdab F, Alipour V, Arabloo J, Asaad M, Banach M, Bijani A, Borzì AM, Briko NI, Castle CD, Cho DY, Chung MT, Daryani A, Demoz GT, Dingels ZV, Do HT, Fischer F, Fox JT, Fukumoto T, Gebre AK, Gebremichael B, Haagsma JA, Haj-Mirzaian A, Handiso DW, Hay SI, Hoang CL, Irvani SSN, Jozwiak JJ, Kalhor R, Kasaeian A, Khader YS, Khalilov R, Khan EA, Khundkar R, Kisa S, Kisa A, Liu Z, Majdan M, Manafi N, Manafi A, Manda AL, Meretoja TJ, Miller TR, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohseni Bandpei MA, Mokdad AH, Naimzada MD, Ndwandwe DE, Nguyen CT, Nguyen HLT, Olagunju AT, Olagunju TO, Pham HQ, Pribadi DRA, Rabiee N, Ramezanzadeh K, Ranganathan K, Roberts NLS, Roever L, Safari S, Samy AM, Sanchez Riera L, Shahabi S, Smarandache CG, Sylte DO, Tesfay BE, Tran BX, Ullah I, Vahedi P, Vahedian-Azimi A, Vos T, Woldeyes DH, Wondmieneh AB, Zhang ZJ, James SL. Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study. Inj Prev 2020; 26:i115-i124. [PMID: 32169973 PMCID: PMC7571361 DOI: 10.1136/injuryprev-2019-043495] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/26/2019] [Accepted: 12/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. RESULTS The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%. CONCLUSIONS Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.
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Affiliation(s)
- Christopher Stephen Crowe
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - Benjamin Ballard Massenburg
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - Shane Douglas Morrison
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - James Chang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, USA
| | - Jeffrey Barton Friedrich
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - Gdiom Gebreheat Abady
- College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Malke Asaad
- Plastic Surgery Department, University of Texas, Houston, Texas, USA
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nikolay Ivanovich Briko
- Epidemiology and Evidence Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Chris D Castle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Daniel Youngwhan Cho
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
| | - Michael T Chung
- Department of Otolaryngology - Head & Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia.,Addis Ababa University, Addis Ababa, Ethiopia
| | - Zachary V Dingels
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Hoa Thi Do
- Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Florian Fischer
- Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
| | - Jack T Fox
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Takeshi Fukumoto
- Department of Dermatology, Kobe University, Kobe, Japan.,Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | | | | | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran.,Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Rovshan Khalilov
- Department of Physiology, Baku State University, Baku, Azerbaijan
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Roba Khundkar
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Zichen Liu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Marek Majdan
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran.,Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Manafi
- Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, Maryland, USA.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | | | - Mohammad A Mohseni Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mukhammad David Naimzada
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia.,Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Kiana Ramezanzadeh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Nicholas L S Roberts
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Saeed Safari
- Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Lidia Sanchez Riera
- Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Institute of Bone and Joint Research, University of Sydney, Syndey, New South Wales, Australia
| | - Saeed Shahabi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Catalin-Gabriel Smarandache
- Surgery 2nd Department - SUUB, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Surgery 2nd Department, Bucharest Emergency Hospital, Bucharest, Romania
| | - Dillon O Sylte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Irfan Ullah
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan.,TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Parviz Vahedi
- Department of Anatomical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Facility, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Dawit Habte Woldeyes
- Department of Human Anatomy, Histology, and Embryology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adam Belay Wondmieneh
- Department of Nursing, Wollo University, Dessie, Ethiopia.,Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zhi-Jiang Zhang
- Department of Preventive Medicine, Wuhan University, Wuhan, China
| | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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22
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Kumar A, Trikha V, Mittal S, Passey J, Chouhan D, Jain A. Fracture of first metacarpal head: A rare case presentation and review of literature. J Clin Orthop Trauma 2020; 11:672-677. [PMID: 32684710 PMCID: PMC7355070 DOI: 10.1016/j.jcot.2019.06.001] [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: 03/21/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022] Open
Abstract
Fractures around the head and neck region of first metacarpal are unusual and have not been reported in literature. We report a case of fracture of head of first metacarpal with intact articular surface, treated with open reduction and internal fixation, with a follow up period of six months. Surgical procedure, intraoperative difficulties in obtaining reduction and steps to overcome them have been described. Satisfactory functional outcomes can be achieved using stable internal fixation with minimal hardware and early mobilization in first metacarpal head fractures.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Vivek Trikha
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Samarth Mittal
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India,Corresponding author. JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Jigyasa Passey
- Department of Anatomy, Maulana Azad Medical College, New Delhi, India
| | - Dushyant Chouhan
- Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India
| | - Aditya Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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23
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Wang D, Sun K, Jiang W. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures. J Int Med Res 2019; 48:300060519887264. [PMID: 31826692 PMCID: PMC7783250 DOI: 10.1177/0300060519887264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To conduct a meta-analysis to show the associations of perioperative and postoperative outcomes of mini-plate internal fixation (MPIF) versus Kirschner wire internal fixation (KWIF) for treating metacarpal and phalangeal fractures. METHODS A literature search was performed in PubMed, Web of Science, Cochrane Library, and Embase from the earliest date of data collection to April 2018. Studies that compared perioperative and postoperative outcomes of MPIF with those of KWIF in patients with metacarpal and phalangeal fractures were included. RESULTS Twenty-six articles met the inclusion and exclusion criteria (n = 2029 patients; 1042 with MPIF and 987 with KWIF). MPIF was related to a greater increase in length of surgery, hospital days, excellent and good rate of outcome, short-form health survey-36 score, and flexion and extension range compared with KWIF. MPIF was related to a greater decrease in intraoperative blood loss, finger visual analog scale score, functional exercise time, fracture healing time, incidence of complications, and postoperative infection rate compared with KWIF. CONCLUSIONS Patients with MPIF have sufficient pressure and strength, and MPIF promotes successful joint fusion and reduces complications of the operation. MPIF is ideal for reduction and stability of patients with metacarpal and phalangeal fractures.
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Affiliation(s)
- Dong Wang
- Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Kai Sun
- Tianjin First Center Hospital, Nankai District, Tianjin, China
| | - Wenxue Jiang
- Tianjin First Center Hospital, Nankai District, Tianjin, China
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24
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Shanmugam R, Jian CYCCS, Haseeb A, Aik S. Comparing biomechanical strength of unicortical locking plate versus bicortical compression plate for transverse midshaft metacarpal fracture. J Orthop Surg (Hong Kong) 2019; 26:2309499018802511. [PMID: 30270746 DOI: 10.1177/2309499018802511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Metacarpal bone fractures constitute 10% of all fractures. Unstable metacarpal fractures require surgical intervention, which poses danger to flexor tendon either due to bicortical drilling or construct of the implant. Unicortical locking plate fixation may be the solution to preventing flexor tendon injury. Studies have compared locking and compression plates. However, in these studies, the biomechanical properties were tested using the static loading method. This study looks into cyclical loading that is more representative of in vivo conditions, particularly for early rehabilitation. We compared the biomechanical strength of the unicortical locking plate and bicortical compression plate system in a transverse metacarpal fracture, tested with cyclical loading and torsion. METHOD Twenty pieces of fourth-generation, biomechanical testing grade, left third metacarpal composite bones were used. Resin was used to create the holding block at both ends of the bone. An oscillating saw with 0.8 mm thick saw blade was used to osteotomize the metacarpal sawbones to create a midshaft transverse metacarpal fracture model. Ten pieces were fixed with a 2.0 mm titanium locking plate via unicortical screw purchase and 10 were fixed with a 2.0 mm, four holes, titanium dynamic compression plate, bicortical purchase of screws. They were subjected to cyclic load to failure testing three-point bending and torsion. RESULTS There were no significant difference in stiffness and cyclic three-point bending to failure between the unicortical locking plate group and the bicortical compression plate group. The bicortical compression plate group is stiffer and has a higher cyclic bending load to failure as compared to the unicortical locking plate group. CONCLUSION Unicortical locking plate fixation of metacarpal fracture can be reliably applied clinically to produce a strong and stable construct that allows early mobilization of the joints. This will not only reduce the complication rate of metacarpal plating, but also improve the functional outcome of the hand.
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Affiliation(s)
| | | | | | - Saw Aik
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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25
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Köse A, Engin MÇ, Topal M, Köse M, Şencan A. Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.468120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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26
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Köse A, Topal M, Engin MÇ, Şencan A, Dinçer R, Baran T. Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:597-604. [PMID: 30426217 DOI: 10.1007/s00590-018-2342-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to present the radiological and clinical results of Kirschner-wire (K-wire) fixation and low-profile plate-screw fixation applied to unstable proximal phalangeal fractures without extension to the joint. METHODS Clinical and radiological data of 22 patients who underwent fixation with open reduction and low-profile 1.5-mm titanium mini plate and unlocked screws and 18 patients who underwent fixation with K-wire due to closed, unstable extra-articular proximal phalangeal fractures were retrospectively examined. All evaluation and statistical analyses were based on sixth postoperative month evaluation parameters. Active and passive metacarpophalangeal joint and interphalangeal joint range of motions, total joint range of motion, measurement of grip strength for fractured and healthy hands, visual analog scoring, disabilities of the arm, shoulder, and hand scores, measurement of distance between the pulpa and palmar curve in the operated finger, Belsky score, reoperation, and complications were evaluated. RESULTS Radiological union was achieved in all patients in a mean duration of 4.2 (3-6) weeks. When the functional results of the patients were evaluated, the mean active metacarpophalangeal joint flexion was 87.3° (75°-90°), mean proximal interphalangeal joint flexion was 94.3° (65°-100°), mean distal interphalangeal joint flexion was 77.6° (75°-80°), and mean total range of motion was 259° (210°-270°). The grip strength of the fractured hand was 52.7 (40-58) kgW, whereas that of the healthy hand was 54.4 (42-60) kgW. The mean value of visual analog score was 0.8 (0-2), mean score for disabilities of the arm, shoulder, and hand was 7 (2-27), and mean distance between the finger pulpa and finger curve was 3 (0-8) mm. CONCLUSION Plate-screw osteosynthesis in the extra-articular, unstable fractures of the proximal phalanx, which is "small" compared with the body but has a "major function" for the hand and upper extremity, allows for rigid fixation, short immobilization, and early motion in spiral/oblique-fragmented fractures. K-wire fixation, an alternative treatment modality, applied to selected fracture patterns with appropriate indications can achieve good-excellent results radiologically and functionally.
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Affiliation(s)
- Ahmet Köse
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Murat Topal
- Department of Orthopedics and Traumatology, Kastamonu University, Kastamonu, Turkey
| | | | - Ayşe Şencan
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Health Sciences University, İstanbul, Turkey
| | - Recep Dinçer
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Tuncay Baran
- Department of Orthopedics and Traumatology, Gölcük State Hospital, Kocaeli, Turkey
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27
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Wang YH, Hao Wong J, Sechachalam S. Carpometacarpal joint flexion view to better visualize base of proximal phalanges of ulnar digits. J Hand Surg Eur Vol 2018; 43:444-445. [PMID: 29199509 DOI: 10.1177/1753193417745758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Yue Han Wang
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jian Hao Wong
- 2 Hand and Microsurgery Section, Tan Tock Seng Hospital, Singapore
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28
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Retrouvey H, Morzycki A, Wang AMQ, Binhammer P. Are We Over Treating Hand Fractures? Current Practice of Single Metacarpal Fractures. Plast Surg (Oakv) 2018; 26:148-153. [PMID: 30148125 DOI: 10.1177/2292550318767926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose We conducted a national survey of Canadian plastic surgeons to assess if inconsistencies in management strategies exist for single metacarpal fractures. Methods A cross-sectional study of Canadian plastic surgeons who perform hand surgeries was conducted. A 15-question survey was distributed to all members of the Canadian Society of Plastic Surgeons. Participants' demographics, practice settings, and current treatment strategies for patients presenting with single metacarpal fractures were evaluated. Results A total of 113 Canadian plastic surgeons met inclusion criteria. The majority of respondents were male (76%), with 50% in practice for more than 15 years. Canadian surgeons used a wide variety of surgical techniques for the management of single metacarpal fractures, with close reduction (94%), Kirshner wires (94%), and splinting and immobilization (89%) being the most common. The majority of plastic surgeons stated that rotational deformity (81%) was the most important indication for surgery. Surgeons demonstrated a trend toward immobilization after splinting (48%), instead of early mobilization after splinting (21%). When results were stratified by years in practice, no differences in surgical and non-surgical management were found, although surgeons in practice for less than 15 years were more likely to suggest hand therapy. Conclusion These findings demonstrate inconsistencies in management of single metacarpal fractures among Canadian plastic surgeons. Surprisingly, surgeons in the survey tended to favor immobilization, as oppose to the literature that favors mobilization. The study highlights the lack of clear guidelines dictating treatment, possibly leading to these inconsistencies.
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Affiliation(s)
- Helene Retrouvey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Annie M Q Wang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Binhammer
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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29
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Jann D, Calcagni M, Giovanoli P, Giesen T. Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws. HAND SURGERY & REHABILITATION 2018; 37:99-103. [DOI: 10.1016/j.hansur.2017.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/19/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
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30
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Timing for Surgical Stabilization with K-wires after Open Fractures of Proximal and Middle Phalangeal Shaft. Sci Rep 2017; 7:11359. [PMID: 28900294 PMCID: PMC5595815 DOI: 10.1038/s41598-017-11918-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 12/02/2022] Open
Abstract
The optimal timing for surgical stabilization after open fractures of proximal and middle phalangeal shaft remained unclear. Total 147 patients with single open fracture in proximal or middle phalangeal shaft (arrived within 8 hours) who received K-wire fixation from June 2012 to June 2015 were included for analysis. The timing for surgical stabilization of fractures (immediate or delayed) was decided according to the surgeons’ preferences. The Michigan hand outcomes questionnaire (MHQ) scores, grip strength and total active motion (TAM) one year after the initial surgery were similar between the two groups. There was no significant difference in the incidence of tenosynovitis, bone nonunion. The overall infection rate in immediate fixation group was slightly but not significantly higher compared with the delayed fixation group (29.2% versus 20.7% P = 0.212). However, patients with both palmar and dorsal wounds who received immediate fixation had much higher infection rate compared with delayed fixation (52.6% versus 22.7%, P = 0.047). The immediate fixation could reduce costs and the period of hospitalization. Open fractures with both palmar and dorsal wounds should be treated with delayed fixation of K-wires otherwise stabilized immediately after injury.
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31
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Liodaki E, Wendlandt R, Waizner K, Schopp BE, Mailänder P, Stang F. A biomechanical analysis of plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to 4-point bending and dynamical bending test. Medicine (Baltimore) 2017; 96:e6926. [PMID: 28682860 PMCID: PMC5502133 DOI: 10.1097/md.0000000000006926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the published literature there are controversial data to the biomechanical stability of monocortical comparing to the bicortical fixation of metacarpal fractures. The aim of this study was to compare the biomechanical stability of monocortical and bicortical locking osteosynthesis in quasi-static and dynamic 4-point bending tests of composite third metacarpal bone (4th Gen third metacarpal, Sawbones, Malmö, Sweden) fixed with 7-hole locking plate (XXS System, Biotech-Ortho, Wright, Memphis, TN). The tests to determine quasi-static yield and bending strength as well as fatigue strength were conducted in 4 groups of 10 samples after creating standardized mid-shaft transverse osteotomies using a diamont belt grinder (0.3 mm saw blade). The force applied was the dorsal apex loading, similar to the forces applied to metacarpals during normal finger flexion and extension.In the quasi-static testing, no plate breakage was observed in each group. All metacarpals broke at their thinnest part. The average bending strength of the bicortical samples (10.54 ± 0.998 Nm) was significantly higher comparing to the monocortical samples (8.57 ± 0.894 Nm) (P < .001).In the dynamic loading test, all constructs (8 monocortical samples and 7 bicortical) that failed broke at the osteotomy site and the average fatigue strength did not differ in both groups.Consequently, a unicortical plating method may provide adequate strength and stability to metacarpal fractures based on the results of the cyclical loading representative of in vivo loading.
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Affiliation(s)
- Eirini Liodaki
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Robert Wendlandt
- Laboratory for Biomechanics, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Klaus Waizner
- Laboratory for Biomechanics, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Brigitte E. Schopp
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Peter Mailänder
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
| | - Felix Stang
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein
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Singla A, Kalsi G, Masih N, Gupta T, Sharma M. Morphological and topographical anatomy of nutrient foramens in human metacarpals and their surgical importance. Surg Radiol Anat 2017; 39:1227-1233. [PMID: 28455539 DOI: 10.1007/s00276-017-1860-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 04/20/2017] [Indexed: 11/28/2022]
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33
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Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures. HAND SURGERY & REHABILITATION 2017; 36:127-135. [DOI: 10.1016/j.hansur.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/10/2016] [Accepted: 08/08/2016] [Indexed: 11/23/2022]
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34
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Treatment of extra-articular proximal and middle phalangeal fractures of the hand: a systematic review. Strategies Trauma Limb Reconstr 2017; 12:63-76. [PMID: 28260179 PMCID: PMC5505877 DOI: 10.1007/s11751-017-0279-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/24/2017] [Indexed: 01/09/2023] Open
Abstract
The aim of the study was to systematically review the patient reported and functional outcomes of treatment for extra-articular proximal or middle phalangeal fractures of the hand in order to determine the best treatment options. The review methodology was registered with PROSPERO. A systematic literature search was conducted in electronic bibliographic databases. Two independent reviewers performed screening and data extraction. The evaluation of quality of the included studies was performed using the Structured Effectiveness Quality Evaluation scale. The initial search yielded 2354 studies. The full text manuscripts of 79 studies were evaluated of which 16 studies met the inclusion criteria. In total, 513 extra-articular proximal and middle phalangeal fractures of the hand were included of which 118 (23%) were treated non-operatively, 188 (37%) were treated by closed reduction internal fixation (CRIF) and 207 (40%) by open reduction internal fixation. It can be recommended that closed displaced extra-articular phalangeal fractures can be treated non-operatively, even fractures with an oblique or complex pattern, provided that closed reduction is possible and maintained. Conservative treatment is preferably performed with a cast/brace allowing free mobilization of the wrist. No definite conclusion could be drawn upon whether closed reduction with extra-articular K-wire pinning or transarticular pinning is superior; however, it might be suggested that extra-articular K-wire pinning is favoured. When open reduction is necessary for oblique or spiral extra-articular fractures, lag screw fixation is preferable to plate and screw fixation. But, similar recovery and functional results are achieved with transversally inserted K-wires compared to lag screw fixation. Type of study/level of evidence: therapeutic III.
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35
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Orthopedics. Biomaterials 2017. [DOI: 10.1016/b978-0-12-809478-5.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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36
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Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e32933. [PMID: 27800460 PMCID: PMC5078834 DOI: 10.5812/atr.32933] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT Hand injuries are a common emergency department presentation. Metacarpal fractures account for 40% of all hand fractures and can be seen in the setting of low or high energy trauma. The most common injury pattern is a metacarpal neck fracture. In this study, the authors aim to review the surgical indications for metacarpal neck fractures, the fixation options available along with the risk and benefits of each. EVIDENCE ACQUISITION Literature review of the different treatment modalities for metacarpal neck fractures. Review focuses on surgical indications and the risks and benefits of different operative techniques. RESULTS The indications for surgery are based on the amount of dorsal angulation of the distal fragment. The ulnar digits can tolerate greater angulation as the radial digits more easily lose grip strength. The most widely utilized fixation techniques are pinning with k-wires, dorsal plating, or intramedullary fixation. There is currently no consensus on an optimal fixation technique as surgical management has been found to have a complication rate up to 36%. Plate and screw fixation demonstrated especially high complication rates. CONCLUSIONS Metacarpal neck fractures are a common injury in young and active patients that results in substantial missed time from work. While the surgical indications are well-described, there is no consensus on the optimal treatment modality because of high complication rates. Dorsal plating has higher complication rates than closed reduction and percutaneous pinning, but is necessary in comminuted fractures. The lack of an ideal fixation construct suggests that further study of the commonly utilized techniques as well as novel techniques is necessary.
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Affiliation(s)
- Eric M. Padegimas
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
- Corresponding author: Eric M. Padegimas, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 516 College, Philadelphia, USA. Tel: +1-2159551500; +1-8606040902, Fax: +1-2155030530, E-mail:
| | - William J. Warrender
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Christopher M. Jones
- Department of Orthopedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, USA
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37
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Aita MA, Mos PAC, de Paula Cardoso Marques Leite G, Alves RS, Credídio MV, da Costa EF. Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw. Rev Bras Ortop 2016; 51:16-23. [PMID: 26962488 PMCID: PMC4767824 DOI: 10.1016/j.rboe.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(®)). METHODS Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(®)). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. RESULTS All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(®)) is effective and safe, and it presents satisfactory clinical-functional results.
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Tratamento cirúrgico minimamente invasivo das fraturas instáveis da falange proximal: parafuso intramedular. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kamath JB, Jayasheelan N, Savur A, Mathews R. Outcome of unstable fractures of metacarpal and phalangeal bones treated by bone tie. Indian J Orthop 2016; 50:316-21. [PMID: 27293294 PMCID: PMC4885302 DOI: 10.4103/0019-5413.181796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Unstable fractures of the metacarpal and phalangeal bones of the hand need surgical stabilization which should be rigid enough for early active mobilization. Conventional methods of open reduction and stabilization in the form of composite fixation or screws with or without plates have served the purpose but can be definitely improvised addressing both biological and mechanical principles of fixation. MATERIALS AND METHODS 34 patients (29 males and 5 females) with an average age of 32 years (range 10-64 years) with unstable fractures of the metacarpal and phalangeal bones of hand who were treated with the modified bone tie between June 2009 and June 2013 were included in this study. 42 fractures, involving the 31 metacarpals and 11 phalanges were included. We have not used this technique in fractures involving the terminal phalanges. Thirty nine of the fractures were treated with K-wires along with the modified bone tie, whereas the other two cases were treated with modified bone tie alone and in one case the bone tie has been used along with the external fixator. The nature of injuries were Road Traffic Accident (n = 24), domestic/industrial injuries (n = 8) and blast (n = 2) injuries. Etiology was crush (n = 24), blunt (n = 7) and incised (n = 3) injuries, respectively. Twenty seven patients were involved with single fractures (either metacarpal or the phalanges), 6 patients had two fractures (both metacarpals or phalanges or one each of metacarpal and phalanx), and 1 patient had three fractures in this study. Dominant hand was involved in 14 patients (40%). RESULTS We achieved excellent to good results in 83% of 42 fractures within an average period of 10 weeks. Postoperative grip strength of 85% was achieved with in an average period of 12 weeks. Twenty six (20 metacarpals and 6 phalanges) of the 42 fractures regained >85% of the total active movements (TAMs) compared to the contralateral side were considered excellent results. All patients were followed up for a minimum of 1 year. CONCLUSION This method of composite fixation allowed the surgeon to remove the concomitantly used axial K-wire at or <3 weeks clearly explaining the biomechanical basis for better results with minimum complication rates.
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Affiliation(s)
- Jagannath B Kamath
- Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India
| | - Nikil Jayasheelan
- Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India,Address for correspondence: Dr. Nikil Jayasheelan, Department of Orthopedics, Kasturba Medical College, Manipal University, Mangalore - 575 001, Karnataka, India. E-mail:
| | - Amaranth Savur
- Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India
| | - Rejith Mathews
- Department of Orthopedics, Kasturba Medical College, Manipal University (Affiliated to Manipal University), Mangalore, Karnataka, India
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Ibanez DS, Rodrigues FL, Salviani RS, Roberto FAR, Pengo Junior JR, Aita MA. Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate. Rev Bras Ortop 2015; 50:509-14. [PMID: 26535195 PMCID: PMC4610986 DOI: 10.1016/j.rboe.2014.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. Methods Polyurethane models (Sawbone®) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. Results Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. Conclusion Stabilization using the Acutrak® screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand®).
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Ibanez DS, Rodrigues FL, Salviani RS, Roberto FAR, Junior JRP, Aita MA. Ensaio experimental para tratamento cirúrgico das fraturas transversas da falange proximal – Técnica com parafuso intramedular cônico de compressão versus placa de compressão lateral. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Shanmugam R, Ernst M, Stoffel K, Fischer MF, Wahl D, Richards RG, Gueorguiev B. Angular stable lateral plating is a valid alternative to conventional plate fixation in the proximal phalanx. A biomechanical study. Clin Biomech (Bristol, Avon) 2015; 30:405-10. [PMID: 25846324 DOI: 10.1016/j.clinbiomech.2015.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dorsal plating is commonly used in proximal phalanx fractures but it bears the risk of interfering with the extensor apparatus. In this study, dorsal and lateral plating fixation methods are compared to assess biomechanical differences using conventional 1.5mm non-locking plates and novel 1.3mm lateral locking plates. METHODS Twenty-four fresh frozen human cadaveric proximal phalanges were equally divided into four groups. An osteotomy was set at the proximal metaphyseal-diaphyseal junction and fixed with either dorsal (group A) or lateral (group B) plating using a 1.5mm non-locking plate, or lateral plating with a novel 1.3mm locking plate with bicortical (group C) or unicortical (group D) screws. The specimens were loaded in axial, dorsovolar and mediolateral direction to assess fixation stiffness followed by a cyclic destructive test in dorsovolar loading direction. FINDINGS Axial stiffness was highest in group D (mean 321.02, SEM 21.47N/mm) with a significant difference between groups D and B (P=0.033). Locking plates (groups C and D) were stiffer than non-locking plates under mediolateral loading (P=0.007), no significant differences were noted under dorsovolar loading. Furthermore, no significant differences were observed under cyclic loading to failure between any of the study groups. INTERPRETATION No considerable biomechanical advantage of using a conventional 1.5mm dorsal non-locking plate was identified over the novel 1.3mm lateral locking plate in the treatment of proximal phalanx fractures. Since the novel low-profile plate is less disruptive to the extensor mechanism, it should be considered as a valid alternative.
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Affiliation(s)
- R Shanmugam
- AO Research Institute Davos, Davos, Switzerland; Orthopaedic Department, University of Malaya, Kuala Lumpur, Malaysia
| | - M Ernst
- AO Research Institute Davos, Davos, Switzerland.
| | - K Stoffel
- Cantonal Hospital Baselland, Liestal, Switzerland; University of Basel, Basel, Switzerland
| | - M F Fischer
- AO Research Institute Davos, Davos, Switzerland
| | - D Wahl
- AO Research Institute Davos, Davos, Switzerland
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Xu J, Zhang C. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis. J Orthop Surg Res 2014; 9:24. [PMID: 24721182 PMCID: PMC3991881 DOI: 10.1186/1749-799x-9-24] [Citation(s) in RCA: 10] [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: 12/04/2013] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
Objectives This meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population. Methods Databases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software. Results A total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = −1.28; 95% CI: −1.81, −0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: −0.34, 1.20; P = 0.27). Conclusions For the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.
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Affiliation(s)
| | - Changqing Zhang
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, Shanghai Province 200233, China.
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