Metacarpal Shaft Research Articles

Comparison between two methods of fixation of Second and Third Metacarpal shaft Fractures: A Meta-analysis

ABSTRACT:Background: Metacarpal bone fractures considered one of the common skeletal fractures, accounting for 36% of all hand and wrist fractures.Patients and Methods: Only clinical studies of both methods used in the management of closed fractures of the second and third metacarpals were included in this review. It also included studies comparing open reduction and int. fixation with plate and screws Vs. percutaneous crossed K -wire fixation for metacarpal fractures. The Ten papers included in the systematic review and meta – analysis were retrospective cohort studies published between 2003 and 2019. The aim of this study is to evaluate the final results and postoperative complications for two methods of fixation within the treatment of fractures of Second and Third metacarpal bones: fixation with plate and screws Vs. percutaneous crossed K -wire.Results: No specifications used for the pattern of fracture, except for the fractures involving shaft of the second and the third metacarpals. All fractures needed to be operated due to deformity, angulations or rotation. No correlation could be done between types of fracture (i.e., spiral, oblique) and functional outcome. As all studies disscused the same indication for intervention, and on the other side, a correlation between type of fixation and functional outcome could be done.Conclusion: No recommendation made that one fixation technique is superior to another, and the complications associated with ORIF or k -wire fixation in the management of metacarpal fractures are distinct.Key words: Open Reduction - Internal Fixation - Percutaneous Kirschner Wires Fixation- fracture 2nd and 3rd metacarpalsFinancial disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.

Homo naledi pollical metacarpal shaft morphology is distinctive and intermediate between that of australopiths and other members of the genus Homo

Homo naledi fossils from the Rising Star cave system provide important insights into the diversity of hand morphology within the genus Homo. Notably, the pollical (thumb) metacarpal (Mc1) displays an unusual suite of characteristics including a median longitudinal crest, a narrow proximal base, and broad flaring intrinsic muscle flanges. The present study evaluates the affinities of H. naledi Mc1 morphology via 3D geometric morphometric analysis of shaft shape using a broader comparative sample (n = 337) of fossil hominins, recent humans, apes, and cercopithecoid monkeys than in prior work. Results confirm that the H. naledi Mc1 is distinctive from most other hominins in being narrow at the proximal end but surmounted by flaring muscle flanges distally. Only StW 418 (Australopithecus cf. africanus) is similar in these aspects of shape. The gracile proximal shaft is most similar to cercopithecoids, Pan, Pongo, Australopithecus afarensis, and Australopithecus sediba, suggesting that H. naledi retains the condition primitive for the genus Homo. In contrast, Neandertal Mc1s are characterized by wide proximal bases and shafts, pinched midshafts, and broad distal flanges, while those of recent humans generally have straight shafts, less robust muscle flanges, and wide proximal shafts/bases. Although uncertainties remain regarding character polarity, the morphology of the H. naledi thumb might be interpreted as a retained intermediate state in a transformation series between the overall gracility of the shaft and the robust shafts of later hominins. Such a model suggests that the addition of broad medial and lateral muscle flanges to a primitively slender shaft was the first modification in transforming the Mc1 into the overall more robust structure exhibited by other Homo taxa including Neandertals and recent Homo sapiens in whose shared lineage the bases and proximal shafts became expanded, possibly as an adaptation to the repeated recruitment of powerful intrinsic pollical muscles.

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

BackgroundMetacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side.ObjectiveThe purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture.Materials and methodsThirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test.ResultsThe maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm).ConclusionAccording to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

A 4-year study of the use of the short metacarpal cast in the management of metacarpal shaft fractures

We report on our experience of using a short, moulded metacarpal cast over a 4-year period in the non-surgical management of metacarpal shaft fractures. Between 6 April 2015 and 6 April 2019, 117 patients were treated using this method. The majority were male, and the mean age was 24.6 years. The most common mechanism of injury was a punch injury (73 patients, 62%). Fifteen patients (13%) were treated for multiple metacarpal fractures. Immediately after cast removal, 68% had a full range of finger movement and 68% were pain free. Few required formal hand therapy. Fifteen patients experienced minor complications, primarily soft tissue irritation from the cast and non-limiting extensor lag. The moulded short metacarpal cast is an effective non-surgical treatment for angulated extra-articular metacarpal fractures of the diaphysis and diametaphyseal junction.Level of evidence: IV.

Percutaneous reduction and fixation technique for 4th metacarpal shaft fracture

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

Protocol for surgical and non-surgical treatment for metacarpal shaft fractures in adults: an observational feasibility study

IntroductionMetacarpal shaft fractures (MSF) are common traumatic hand injuries that usually affect young people of working age. They place a significant burden on healthcare resources and society; however, there is...

Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures.

We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation. Transverse mid-diaphyseal fractures were created in 64 metacarpal sawbones and were assigned into four groups. Peak load to failure and stiffness were measured in cantilever bending and torsion. We found that dorsal plating had the highest peak load to failure. However, initial bending stiffness of the 3.0 mm intramedullary headless compression screw was higher than that of the dorsal plates. In torsion testing, dorsal plating had the highest peak torque, but there was no significant difference in torsional stiffness between the plate and intramedullary headless compression screw constructs. We concluded that intramedullary headless compression screw fixation is biomechanically superior to K-wires in cantilever bending and torsion; however, it is less stable than dorsal plating. In our study, the initial stability provided by K-wire fixation was sufficient to cope with expected loads in the early rehabilitation period, whereas dorsal plates and IHCS constructs provided stability far in excess of what is required.

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

BackgroundMetacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure.ObjectiveTo evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires.Materials and methodsWe used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force–displacement data. The Mann–Whitney U test was used to compare between-group differences in maximum fracture force and stiffness.ResultsThe maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p < 0.05; Figure 5a), with the median of the KP&F8 group exceeding that of the KP group by 57.5%. Similarly, stiffness was significantly lower in the KP group (18.14 ± 9.84 N/mm) than in the KP&F8 group (38.25 ± 23.49 N/mm; p < 0.05; Figure 5b), with the median of the KP&F8 group exceeding that of the KP group by 110.9%.ConclusionThe incorporation of a figure-of-eight cerclage wire increased the maximum fracture force and stiffness by 57.5 and 110.9%, respectively, compared with those achieved in standard two K-wire fixation. Therefore, hand surgeons are advised to consider the proposed approach to increase fixation strength.

A Single Intramedullary K-Wire Is Sufficient for the Management of Nonthumb Metacarpal Shaft Fractures.

Objective This study aims to evaluate the outcome after the internal fixation of diaphyseal metacarpal fractures by a single intramedullary K-wire. Methods In this prospective case series study, conducted from July 2017 to June 2019 in 23 adult patients with a single, unstable, diaphyseal metacarpal fracture, outcomes after internal surgical fixation using a single antegrade intramedullary K-wire were evaluated. The outcomes were evaluated by union rate, time to union, handgrip measurements at 6 and 12 months, and the modified Disabilities of the Arm, Shoulder, and Hand (DASH) score at 12 months. Results The study population consisted of 17 males and 6 females, with a mean patient age of 28.4 ± 8.5 years (range, 16–45 years). The median time to final follow-up was 14 ± 1.8 months (range: 12–24 months). The mean duration of the union was 7.3 ± 1.6 weeks (range: 5–11 weeks), with a union rate of 95.7% (22 cases). The mean handgrip strength was 68% ± 12.8% of the strength of the uninjured hand after 6 months and 92.7% ± 6.9% after 12 months. The mean modified DASH score was 2.6 ± 0.26 after 12 months (range: 0–5.8). There were no cases of malrotation or infection. In conclusion, using a single 1.8–2.0 mm K-wire gives excellent functional outcomes and union rate without significant complications when used to treat an unstable metacarpal shaft fracture.

Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures.

This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.

Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

BackgroundMetacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct.MethodsFive matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated.ResultsFor transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups.ConclusionIntramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work.Level of evidenceBasic Science Study, Biomechanics.

Effect of Bicortical Interfragmentary Screw Size on the Fixation of Metacarpal Shaft Fractures: A 3-Dimensional-Printed Biomechanical Study

PurposeSpiral metacarpal fractures fixed with 2 non-lagged, interfragmentary cortical screws were tested to failure. The effect of screw size (1.2 mm, 1.5 mm, 2.0 mm, and 2.3 mm) on construct strength was tested in 3-point bending.MethodsThree-dimensional-printed metacarpal test models were reproduced from computed tomography scans to reduce the confounding variables of bone density and anatomy, often encountered when using cadavers.ResultsNo significant difference was found between the screw sizes, and the peak failure force was similar. Drill bit fracture and deformation during the insertion of the smallest screw (1.2 mm) as well as model failure during the insertion of the largest screw (2.3 mm) were found in some cases.ConclusionsScrews of 1.5 mm and 2.0 mm in diameter were of sufficient strength and did not have the issues encountered with smaller or larger screws. Concerns from previous authors regarding intraoperative fracture were consistent with the pre-testing failure of some 2.3-mm models.Clinical RelevanceScrews of 1.5 mm or 2 mm appear adequate for the fixation of spiral fracture patterns in metacarpal shafts using bicortical non-lagged technique with a low risk of fixation complications.

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

BackgroundMetacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.ObjectiveWe propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.Materials and methodsWe used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.ResultsThe maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.ConclusionHeadless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Comparative Study Between Intramedullary K Wires Versus Mini-plates and Screws in Fixation of Metacarpal Shaft Fractures in Adults

Abstract Background: Percutaneous intramedullary K. wires fixation and mini-plates fixation are reasonable options for treating unstable metacarpal fractures as they provide anatomical reduction and rigid fixation, which is adequate to permit early mobilization. Objective: To compare between mini-plates and Kirschner wires in management of unstable metacarpal shaft fractures in adults. Patients and Methods: All patients (n=30) included in this prospective comparative study were managed and followed up at Al-Azhar University Hospital from January 2019 to February 2020. Thirty patients with fracture of shaft metacarpal were divided into 2 groups: group A (n=15) were managed by percutaneous intramedullary K-wires and group B (n=15) were managed by mini-plates. Results:27 Patients were males and 3 were females . Dominant hand affection were in 20 patients . All patients had a complete union between 4-8 weeks for group A with average of 6 weeks and 6-10 weeks for group B with average of 8 weeks. The total result according to TAF score, Quick DASH score, and handgrip was excellent in 10 cases, good in 4 cases, and fair in 1 case in group A, while group B was excellent in 10 cases, good in 3 cases, fair in 1 case and poor in 1 case. Conclusion: Both techniques are highly effective for fixation of metacarpal shaft fractures. Mini-plate fixation provides rapid recovery of hand function and K-wire fixation allows a wide range of hand motion and soft tissue preservation.

Evaluation of Antegrade Intramedullary Compression Screw Fixation of Metacarpal Shaft Fractures in a Cadaver Model

Surgical options for displaced metacarpal shaft fractures include the use of Kirschner wires, plates and screws, and most recently, intramedullary headless compression screws (IMHCS), which have been reported using only retrograde insertion through the metacarpal head. We evaluated IMHCS fixation of metacarpal shaft fractures through an antegrade approach in a cadaver model. We performed antegrade placement of IMHCS in 10 cadaver hands including all 5 digits (total of 50). Displaced transverse proximal metacarpal shaft fractures were created and reduced with a retrograde guidewire from the metacarpal head across the shaft fracture andexiting the metacarpal base. This was retrieved through a 6-mm dorsal wrist incision and overdrilled before the placement of a 4.1-mm-diameter IMHCS in the ring finger and a 4.7-mm screw in all other metacarpals. After IMHCS placement, carpometacarpal (CMC) joint violation was measured along with the optimal starting point for the guidewire on the metacarpal head relative to the dorsal cortex. In all 50 metacarpals, we achieved successful fracture reduction and fixation without violating the extensor mechanism at the wrist. Our retrograde guidewire entry point through the metacarpal head ranged from 4.2 to 4.7 mm volar to the dorsal cortex. The actual area of CMC joint violated by IMHCS placement was largest in the index CMC joint (4.9%), followed by the middle (3.7%), little (2.9%), ring (0.5%), and thumb joints (0.2%). Placement of IMHCS through an antegrade approach from the CMC joint can be performed effectively for all transverse metacarpal fractures, including the thumb, using a limited incision. There is minimal violation of the articular surfaces of the trapezium, capitate, and hamate for the thumb, middle, ring, and little metacarpals. Antegrade IMHCS fixation successfully avoids the potential morbidity of creating a metacarpal head articular surface or extensor mechanism defect at the metacarpophalangeal joint seen with the retrograde approaches.

Single Antegrade Intramedullary Kirschner Wire Fixation For Transverse Metacarpal Shaft Fractures: A Retrospective Review

Introduction: Fractures of the metacarpals are frequently encountered. Transverse metacarpal shaft fractures are inherently unstable and amenable to surgical intervention. Few studies have evaluated outcomes of patients with a singular transverse metacarpal shaft fracture surgically corrected with an antegrade intramedullary Kirschner (K) wire. We present our series of patients and their outcomes performed by a single surgeon. Materials and Methods: A retrospective chart review of cases at our institution was performed on transverse metacarpal fracture treated with an intramedullary K-wire. Fifteen patients met the inclusion criteria. Data extracted included metacarpal involved, laterality, sex, age, if removal of hardware was performed, time from initial injury to surgery, tourniquet time, complications, range of motion, clinical outcome, among others. Results: All fractures occurred about the right hand with 7 involving the small finger metacarpal, 4 involving the index, 3 involving the ring, and 1 involving the middle. The average patient age was 25 years (range: 18 to 58 y). The average tourniquet time was 16 minutes (range: 10 to 20 min). There were no intraoperative complications and 1 patient had hardware removed at 8 weeks due to proximal pin site pain. All patients achieved clinical union with a return of full function. Discussion: Single antegrade intramedullary K-wire fixation is a simple, reliable, and potentially cost-effective treatment option for transverse metacarpal shaft fractures. Further research is needed to determine long-term outcomes and formal cost analysis. Our series indicate this technique can be safely utilized, with a low risk of complications and good clinical outcomes. Level of Evidence: Level IV—therapeutic.

A Systematic Review of Treatment Interventions for Metacarpal Shaft Fractures in Adults.

Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. A comprehensive search was conducted across multiple databases, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1600 records were identified; 7 studies fulfilled eligibility criteria and were included. No randomized controlled trials directly comparing surgery with nonsurgical treatment were found. One retrospective study compared nonsurgical with surgical treatment, whereas 6 compared surgical or nonsurgical treatments. Considerable heterogeneity between studies along with a high or critical risk of bias restricts direct comparison and conclusions. There is a lack of high-quality evidence to guide treatment, supporting the need for well-designed, multicenter trials to identify the most effective and cost-efficient treatment for metacarpal shaft fractures in adults.

Role of aspanning plate as an internal fixator in complex distal radius fractures.

Minimally invasive temporary internal wrist arthrodesis as an alternative treatment method in complex distal radius fractures. Complex distal radius fractures with dorsal and/or palmar comminution and little to no reconstruction possibilities, radiocarpal ligamentous injury, need for early weight bearing through the affected wrist (walking aids). Complex hand injuries limiting the possibility to safely secure the plate at either the metacarpal or the radial shaft. Percutaneous or open reduction and fixation of the distal radius fracture. Determine the location for the two stab incisions under fluoroscopy; one over the distal radial diaphysis and one over the second or third metacarpal. Athird incision over Lister's tubercle allows transposition of the extensor pollicis longus (EPL) tendon, excision of the posterior interosseous nerve and dorsal arthrotomy. Retrograde insertion of the spanning plate. Placement of afirst nonlocking screw through the glide hole into the metacarpal shaft. Under traction, aproximal screw hole is filled with anonlocking screw into the radial diaphysis. Tightening of the cortical screws under lateral fluoroscopic view. The remaining screw holes at both the distal and proximal ends of the plate are filled with locking screws. Layered wound closure. A removable wrist splint is worn during 2weeks. Weight bearing through the injured wrist is immediately allowed. Removal of the spanning plate is scheduled at 3months after radiographic evidence of fracture consolidation. In total, twelve distal radius fractures were treated by dorsal spanning plate fixation between January 2018 and January 2019. Average age was 53.3 ± 24.5years (range 22-95years). Both 3.5 mm and 2.4/2.7 mm plates were used. All twelve fractures were healed after 3months. The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 36.4 (range 8.3-70.0). There was one EPL tendon rupture, one case with extensor tendon adhesions, one periosteosynthetic fracture of the radial shaft and one complex regional pain syndrome. There was no implant failure and no infection.

Ring finger metacarpal fracture iatrogenic rotation using an ulnar gutter splint: A cadaveric study

Study DesignCohort cadaveric study. IntroductionRing finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic “molding”, resulting in a crossover deformity of the ring finger over the small finger. Purpose of the StudyThe goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. MethodsTransverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. ResultsThere was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). ConclusionsApplication of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.