Fixation Of Metacarpal Fractures Research Articles

Clinical Outcomes of Limited Open Intramedullary Headless Screw Fixation of Metacarpal Fractures in 91 Consecutive Patients.

Background: The objective of the study is to evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless screw (IMHS) fixation for metacarpal neck and shaft fractures. Methods: Retrospective review of 91 consecutive patients (79 men; 12 women), mean age 28 (range =15-69) years, treated with IMHS fixation for acute displaced metacarpal neck (N = 56) and shaft (N = 35) fractures at a single institution. Mean follow-up was 10 (range = 1-71, median = 3) months. Preoperative mean magnitude of metacarpal neck angulation was 48° (range = 0°-90°), and mean shaft angulation was 42° (range = 0°-70°). Active motion was initiated within 5 days postoperatively. Clinical outcomes were assessed with digital goniometry, grip strength, and return to full activity. The time to radiographic union and radiographic arthrosis was assessed. Results: All 91 patients achieved full functional arc of metacarpophalangeal (MCP) motion, and all achieved full active MCP extension or hyperextension. At mean follow-up of 10 months, postoperative mean MCP joint flexion-extension arc was 88° (range = 55°-110°). Grip strength was available for 52 patients and measured 104.1% of the contralateral hand (range = 58%-230%). Radiographic union data were available for 86 patients. Seventy-six percent (65/86) achieved radiographic union by the end of week 6 (range = 2-10 weeks). Early arthrosis was noted in 1 patient at the MCP. There were 3 cases of shaft refracture after recurrent blunt trauma, following prior evidence of full osseous union. Conclusions: The IMHS fixation is safe, reliable, and durable for metacarpal neck/subcapital, axially stable shaft fractures, and select delayed unions or malunions. It allows for early postoperative motion without affecting union rates and obviates immobilization. This technique offers distinct advantages over formal open reduction and percutaneous Kirschner wire techniques.

90/90 Bicortical, double-loop, interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures

Background: The purpose of this study was to determine the effectiveness of 90/90 interosseous wiring for fixation of transverse and short oblique metacarpal shaft fractures on early motion. Methods: This prospective study was conducted at an academic Level 1 trauma Center from 2015 to 2017. The study included 20 patients (16 males and 4 females). The mean age was 27.3 yr (range, 12 to 44 yr). The dominant hand was affected in 10 patients, and the nondominant hand was affected in the other 10 patients. Regarding the fracture pattern, 17 were transverse and three were short oblique fractures. The mean follow-up period was 6 mo (range, 4 to 8 mo). Patients were assessed for union (clinically and radiographically), range of motion (total active motion [TAM] and total active flexion [TAF]), hand grip strength, and patient-reported outcome using the quick-Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: All patients achieved union after a mean of 7 wk (range, 6 to 8 wk). The mean TAF was 246 degrees (range, 150̊ to 260 degrees). TAM was excellent in 13 digits and good in seven digits. The mean grip strength was 90.20% (range, 61.53% to 100%) of the unaffected side. The mean quick-DASH score was 2.72 (range, 0 to 20.45). Conclusions: The interosseous wiring technique is an effective method of fixation that can be used alone for transverse or short oblique fractures of the metacarpal and can permit early hand mobilization postoperatively without loss of reduction.

Study of cross pinning of metacarpal and proximal phalangeal fracture of the hand

Introduction: A majority of metacarpal and proximal phalynx fracture can be effectively managed with closed reduction and cast and buddy taping. However a group metacarpal and proximal phalynx fractures are unstable and reducible, but difficult to put in reducible position within plaster cast or buddy taping till union of the fractures, for those fractures cross pinning with ‘k’ wires is required. Lots of other technique i.e. external fixation, miniplate, L pinning for fixation of metacarpal and proximal phalynx fracture are also available. Aim: Aim of this study is Functional outcome of cross pinning of metacarpal and proximal phalanges fracture of the hand. Material and method: 25 patients with metacarpal and phalynx fracture were treated with cross intramedullary ‘k’ wire fixation between June 2016 – 2018 in Pravara rural hospital-loni (Maharashtra). Out of 25 patients 18 are males and 7 are females, of which 14 were having metacarpal fracture and 11 were having proximal phalynx fracture. Result: All 25 patients were followed up for more than 3 months. 1 patient (female) developed sudecks osteodystrophy. At final follow up 4 patients had residual pain measuring 2-3 on visual analogue scale. All patients regained full range of motion at metacarpo-phalyngeal and interphalyngeal joints. Fracture union was evaluated at each x-ray and patient satisfaction was evaluated as excellent, good, fair or poor. Discussion: In our study early mobilisation of the joint to reduce the stiffness k wires used for fixation are cheap, easily available and doesn’t require costly instrumentation. Clinicoradiological confirmation was done at the end of every surgery to confirm acceptable reduction. There was no clinical shortening of metacarpals and phalanges. Conclusion: Comminutted fractures and intra-articular fractures, k wire not suitable. It is relatively simple, cost effective and definite advantages over other techniques for fracture stabilisation.

Abstract: Surgical Fixation of Metacarpal Shaft Fractures Using Absorbable Implants: An Update of the Literature

BACKGROUND: Despite the proven efficacy and advantages of absorbable implants, their use for metacarpal shaft fixation has been limited. This is likely due to the high reported complication rates in early studies with polyglycolic acid (PGA) implants, notably high rates of noninfectious inflammatory reaction (5–25%), occurring up to 30 weeks after fixation. The objective of this study was to assess the clinical outcomes of newer absorbable plates and screws composed of polylactic acid (PLA) in the treatment of metacarpal shaft fractures. We hypothesize that our findings will support the use of PLA implants for metacarpal fracture fixation. METHODS: The authors performed a systematic search of the PubMed, Ovid MEDLINE and EMBASE databases dating from 1946 to 2017. Primary outcome measures were the development of non-infectious inflammatory reaction and implant failure. RESULTS: A total of 42 metacarpal shaft fractures in 35 patients were included in this study. The average follow-up time was 20.4 months (n=24; range: 3.6–61 months). Only 1 case (2.4%) of non-infectious inflammatory reaction was reported with polylactic acid (PLA) plates and PLA/PGA compounds. Non-infectious inflammatory reaction was observed in 4 out of the 9 patients (44.4%) with a trimethylene carbonate/PLA compound. Symptoms appeared after an average time of 15.8 months (range 12–19 months) post-fixation. Painless prolonged inflammation that resolved spontaneously within 6 months was reported in 7.1% of cases (n=3). Implant failure with loss of fracture reduction was reported in 9.5% of cases (n=4). CONCLUSION: Newer absorbable materials (PLA or PLA/PGA) appear to have significantly lower rates of noninfectious inflammatory reaction than previously reported. When compared to metallic fixation of the metacarpal shaft, absorbable fixation appears to have comparable complication rates and biomechanical properties.

Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws

We analyzed the results of 20 unstable metacarpal fractures in 15 patients treated with a cannulated compression screw and no immobilization. All fractures healed within 6 weeks. One patient with multiple fractures and a flexion deficit required arthrolysis of two metacarpophalangeal joints. Another patient had an extension lag. There were no other complications. This fast and easy technique results in good outcomes for unstable metacarpal fractures. The advantages are early active motion without immobilization and stable fixation. Surgical removal of the screw is rarely needed. Level of evidenceIV (therapeutic).

Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes.

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Abstract: Outcomes of Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws: A Literature Review

INTRODUCTION: Metacarpal fractures are a common occurrence in the United States, making up 33.3% of all hand fractures. The majority can be treated nonoperatively, but surgery is indicated when fractures cannot be reduced or fracture alignment cannot be stabilized using closed methods. In 2010, Boulton et al reported intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture. This method has since been described as an operative technique for displaced, comminuted subcapital, and metacarpal neck and shaft fractures. The purpose of this review is to evaluate the recent studies reporting on the outcomes of intramedullary screw fixation of metacarpal fractures. METHODS: Pubmed, Web of Science, and Cochrane were searched. All outcome data from articles reporting on the use of intramedullary screws for the treatment of metacarpal fractures were combined. RESULTS: A total of five articles, one of which was the original case report, were identified for a total of 115 metacarpal fracture repairs performed using intramedullary screw fixation. The majority (84%) were in the small finger with fracture location in the metacarpal neck (69%). All studies used 2.4mm or 3.0mm screws ranging from 32-50mm in length for fixation. Average follow-up was 14 months with an average MCP flexion of 82 degrees (n=78). One study (n=18) did not record MCP flexion, but reported each digit to have a total active motion >240 degrees. All but one study measured radiographic union as an outcome, and all (n=78) resulted in 100% union at or before the latest follow-up. Additionally, grip strength was assessed in two studies (n=29), which showed an average of at least 98% of the contralateral hand. No serious complications were reported. Only one hardware removal was performed due to radiographic suspicion of intra-articular screw penetration. Of note this was a complication of the Y strutting technique in which two intramedullary screws are placed. CONCLUSION: Intramedullary fixation of metacarpal fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option for metacarpal fractures. Advantages of this technique over previously described methods (intramedullary nail or percutaneous K-wire fixation) include no requirement of K-wire removal and increased rotational stability, thus allowing for earlier mobilization.

Functional outcome in metacarpal fractures treated with Minifragment plating

There is trend on rise to use miniplates over the kirschner’s wire for treating the fractures of hand. The improved system of internal fixation by miniplates has many advantages. The aim of the study was to evaluate whether the newer stable fixation method i.e plating has any significant advantage. The study included a total of 20 cases with individuals ageing greater than 18 years. The patients excluded from the study were who had compound injury, severe osteoporosis and severe comorbid conditions in whom risk of anaesthetic complications were high. The average time for radiological union was 8.7 weeks. Stiffness was the most common associated complication in this study. 8 patients (40%) had shown excellent results; 9 patients (45%) had shown good results; 3 patients had shown fair results and none reported poor result. Plating is an excellent method of fixation in metacarpal fractures.

Evidence-Based Medicine: Management of Metacarpal Fractures.

After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical intervention is needed for metacarpal fractures. 3. Understand the various treatment options for surgical fixation of metacarpal fractures. 4. Describe the role for external fixation in managing difficult metacarpal fractures. Metacarpal fractures are common injuries that plastic surgeons should be able to evaluate and treat. The goal of this review is to highlight current evidence for managing metacarpal fractures. This Continuing Medical Education article consists of a literature review, illustrations, videos, and an online Continuing Medical Education examination. The authors reviewed the scientific literature from 2000 to 2015 regarding treatment of metacarpal fractures. Cadaver models were used for instructional videography demonstrating common surgical techniques. Multiple-choice questions were created to review pertinent topics. A discussion and references are provided. Numerous treatment options have been described for metacarpal fractures, including splinting, percutaneous fixation, open reduction with internal fixation, and external fixation. All modalities are acceptable strategies for treating metacarpal fractures. The ultimate goal is to maximize hand function with minimal morbidity. A thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures. Although the current literature supports a wide array of treatment strategies, high-level evidence to guide fracture management remains lacking.

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.

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.

Comparison of the effects of absorbable rod and mini-plate fixation for the treatment of oblique metacarpal fractures

Objective To assess the clinical results of metacarpal fracture fixation by mini-plates and absorbable rods. Methods From January 2013 to May 2016, 95 metacarpal fractures in 80 cases were assigned to absorbable rod fixation group (31 fractures in 29 cases) and mini-plate fixation group (64 fractures in 51cases). Results Postoperatively all the cases were follow-up for 3 to 12 months (average, 7.6 months). All fractures healed. The clinical results of both groups were assessed by the upper extremity functional evaluation criteria issued by TAFS. In the mini-plate group 31 fractures were graded as excellent, 25 as good and 8 as poor. In the absorbable rod group 19 fractures were graded as excellent, 11 as good and 1 as poor. There were no statistically significant differences between the two implant types. Conclusion Both types of implants seem to be equally effective and safe for metacarpal fracture fixation. The absorbable rod fixation is an easy procedure for oblique metacarpal fracture. It achieves the rigidity required for internal fixation. It will break down over time leaving no foreign body and stress shield, and does not require a secondary surgery to remove the implant. It is an ideal and effective treatment. Key words: Metacarpal bones; Fractures,bone; Absorbable rod; Mini-plates

Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures

To determine whether there is a difference in the incidence of infection between exposed and buried K-wires when used to treat phalangeal, metacarpal, and distal radius fractures. We conducted a retrospective review identifying all patients aged greater than 16 years who underwent fixation of phalangeal, metacarpal, or distal radius fractures with K-wires between 2007 and 2015. We recorded patient demographic data, fracture location, number of K-wires used, whether K-wires were buried or left exposed, and duration of K-wire placement. A total of 695 patients met inclusion criteria. Surgeons buried K-wires in 207 patients and left K-wires exposed in 488. Infections occurred more frequently in exposed K-wire casesthan in buried K-wire ones. Subgroup analysis based on fracture location revealed a significantly increased risk of being treated for infection when exposed K-wires were used for metacarpal fractures. Patients with exposed K-wires for fixation of phalangeal, metacarpal, or distal radius fractures were more likely to be treated for a pin-site infection than those with K-wires buried beneath the skin. Metacarpal fractures treated with exposed K-wires were 2 times more likely to be treated for a pin-site infection (17.6% of exposed K wire cases vs 8.7% of buried K wire cases). Therapeutic IV.

Locking Plate Alone versus in Combination with Two Crossed Kirschner Wires for Fifth Metacarpal Neck Fracture

Fracture of fifth metacarpal neck commonly requires open reduction and internal fixation. However, the current methods of internal fixation in fifth metacarpal neck fractures remain unsatisfactory. Patients with fractures of fifth metacarpal neck received open reduction and internal fixation with either locking plate in combination with two crossed Kirschner wires (K-wires) or locking plate alone were evaluated for the clinical outcomes. Clinical outcomes included grip strength, Michigan hand outcomes questionnaire (MHQ), final angulation and range of motion (ROM) one year after treatment. The averages of MHQ scores, final angulation and ROM of fifth metacarpophalangeal joint of plate with K-wire group were more superior to those of plate group (MHQ 96.7 versus 86.6, final angulation 11.8 versus 23.6, ROM 83.3 versus 72.2). The grip strength had no significant difference between two groups. Locking plate in combination with two crossed K-wires is a more optimal method of fixation compared with locking plate alone.

Metacarpal shaft fracture fixation with intramedullary k-wire: Surgical and Clinical outcomes

Background: Metacarpal fractures are among the most common fractures. The majority of metacarpal shaft fractures can be treated conservatively. There are numerous indications for operative treatment and various fixation techniques. The purpose of this prospective study was to assess the surgical and clinical outcomes of metacarpal shaft fractures using intramedullary fixation by K-wire (Kirschner wire). Materials and Methods: 15 cases of Metacarpal shaft fractures underwent surgery with Intra medullary fixation by K-wire. The study was conducted from March 2015 to February 2016 admitted to Navodaya Medical College and research center, Raichur. We evaluated the DASH score to determine the outcomes. Results: All fractures got united in our study and all patients were available for follow up. Two superficial wound (pin site) infections noted which healed with intravenous antibiotic treatment and regular pin site dressing. There were no major complications noted. All patients regained full flexion at the MCP and IP joints but two patients had a mild extensor lag of about 10°. At final follow up the mean DASH score in our study was 4.3 (range: 0-7.2). Conclusion: Closed or minimally invasive fixation with Kirschner wire (k-wire) is a safe method and can be performed with minimal complications. It can be seen as good choice in selective metacarpal shaft fractures.

Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study

This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. Eight matched-paired hands (n= 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neckfractures.

Metacarpal fractures in the athlete.

To describe current evaluation and treatment of metacarpal fractures in athletes RECENT FINDINGS: Biomechanical and clinical studies involving lower-profile, locking, shorter length, and double-row or separate-dual plate configurations, as well as intramedullary screw fixation, have demonstrated the potential benefits of internal fixation with promising results. Treatment should be customized to the specific athlete and injury, and is often successful without surgery, or with percutaneous pin fixation. Internal fixation of metacarpal fractures has improved with new hardware and new techniques, and may expedite return to play, although further clinical studies are needed.

A Study on Functional Outcome of Various Modalities of Internal Fixation of Metacarpal and Phalangeal Fractures of Hand - A Prospective Study

A Study on Functional Outcome of Various Modalities of Internal Fixation of Metacarpal and Phalangeal Fractures of Hand - A Prospective Study

The Use of Minilocked Plate for Management of Unstable Metacarpal Fractures.

Objective This study aims to evaluate the use of minilocked plates in the treatment of the metacarpal fractures. Method A total of 30 patients of metacarpal fractures were treated by minilocked plates. Results Union was achieved in all patients. There were 27 (90%) patients having satisfactory results (excellent and good results) and 3 patients (10%) had poor results. Conclusion The use of minilocked plate is recommended for fixation of periarticular, comminuted, and osteoporotic metacarpal fractures that offer rigid fixation early mobilization, decreases the incidence of joints stiffness, and tendon adherence which maximized the hand function.

Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Common Hand Surgery Procedures

To evaluate prolonged opioid use in opioid-naïve patients after common hand surgery procedures in the United States. We studied insurance claims from the Truven MarketScan databases to identify opioid-naïve adult patients (no opioid exposure 11 months before the perioperative period) who underwent an elective (carpal tunnel release, carpometacarpal arthroplasty/arthrodesis, cubital tunnel release, or trigger finger release) or trauma-related (closed distal radius fracture fixation, flexor tendon repair, metacarpal fracture fixation, or phalangeal fracture fixation) hand surgery procedure between 2010 and 2012 (N= 77,573 patients). Patients were observed for 6 months to determine the number, timing, duration, and oral morphine equivalent dosage of postoperative opioid prescriptions. We assessed prolonged postoperative opioid use, defined as patients who filled a perioperative opioid prescription followed by a prescription between 90 and 180 days after surgery, and evaluated associated risk factors using multivariable logistic regression. In this cohort, 59,725 opioid-naïve patients (77%) filled a perioperative opioid prescription. Of these, 13% of patients continued to fill prescriptions between 90 and 180 days after surgery. Elective surgery patients were more likely to continue to fill opioid prescriptions after 90 days compared with trauma patients (13.5% vs 10.5%). Younger age, female gender, lower income, comprehensive insurance, higher Elixhauser comorbidity index, mental health disorders, and tobacco dependence or abuse were associated with prolonged opioid use. Approximately 13% of opioid-naïve patients continue to fill opioid prescriptions after hand surgery procedures 90 days after surgery. Preoperative interventions centered on opioid alternatives and early cessation, particularly among patients at risk for long-term use, is critical to addressing the prescription opioid crisis in the United States. The current national opioid use epidemic requires an assessment of the prevalence of hand surgery patients who receive and fill opioid prescriptions after common hand surgery procedures.

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws.

Introduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.