Fixation Of Metacarpal Fractures Research Articles

Metacarpal and Proximal Phalangeal Fracture

Purpose: The purpose of this study was to present a new technique for fixation of metacarpal and proximal phalangeal fractures. This hybrid dynamic minifix, as called for us, consists of a combination of intramedullary fixation and external fixation, stable but not a rigid fixation that permits early motion. Methods: We present a retrospective study of 33 with extra-articular metacarpal (14) and proximal extra-articular phalangeal (19) fractures with a minimum of 3 months of follow-up, range from 3 to 8 months. The patients were clinically and radiologically evaluated using range of motion, time to healing, time to get back to work, complication, and patient’s satisfaction. Results: All fractures got healed with the average time to union being 4 weeks. No differences were statistically significant to any aspect evaluated; all patients were satisfied and all of them got back to work in an average time frame of 2 months. Conclusion: This technique provides stable fixation, associated with a low complication rate; at the same time, it avoids the disadvantages of the open fixation and permits early motion. It showed to be safe and effective when used for treatment of extra-articular metacarpal and proximal phalangeal fractures.

Commentary on Unicortical fixation of metacarpal fractures: is it strong enough? J. K. Dickson, W. Bhat, S. Gujral, J. Paget, J. O'Neill and S. J. Lee. J Hand Surg Eur. 2016, 41: 367-72.

Commentary on Unicortical fixation of metacarpal fractures: is it strong enough? J. K. Dickson, W. Bhat, S. Gujral, J. Paget, J. O'Neill and S. J. Lee. J Hand Surg Eur. 2016, 41: 367-72.

Unicortical fixation of metacarpal fractures: is it strong enough?

Unicortical fixation has some practical and theoretical advantages over bicortical fixation. Questions have been raised to its adequacy for post-operative mobilization. We hypothesized that fixation using a plate and eight unicortical screws would be as strong as using a plate and four bicortical screws. A total of 40 unicortical and 40 bicortical fixations were compared using a cadaveric metacarpal model. Unicortical fixation was performed using an eight-hole parallel plate and bicortical fixation with a four-hole straight plate. Fixations were tested to failure using four-point bending load. The mean load to failure was 414 N SD 38(SE) for the unicortical group and 296 N SD 29(SE) for the bicortical group. Significant differences between these two constructs were observed. The mean stiffness of the fixation was higher for the bicortical group than the unicortical, although this difference did not reach significance. Unicortical fixation alone is sufficient to enable early post-operative mobilization in a live model.

Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures

To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires. Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct. All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size. The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires. When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability inthe plane of finger flexion-extension.

(371) Pain over the dorsum of third metacarpophalangeal joint: which nerve to block, radial or ulnar?

The distribution of radial and ulnar nerve on the dorsum of hand seems pretty demarcated in textbooks. However overlap or crossover of nerve distribution might happen especially after injury or surgery. In this case report, a 42 year old male suffered right third metacarpophalageal (MCP) joint fracture with a traumatic degloving type laceration over the dorsal aspect of the right hand over a year ago. He had open reduction and internal fixation of right middle metacarpal fracture and wrist external fixation surgery on the same day of injury. Six months after surgery, patient was referred to our pain clinic for persistent pain over the right third MCP joint which completely resolved after scar injection. However, the pain relief only lasted for couple days. Patient subsequently had right superficial radial nerve block which only provided 20-25% instant pain relief. Scar injection with Botox provided complete pain relief which unfortunately only lasted for about a month. Patient subsequently went through a second hand surgery for excision of an osteophyte at the radial side of the right third MCP joint. Also a radial sensory neuroma was identified during the surgery which was buried into distal right radius. However three months later, patient returned to the clinic with persistent pain over the same location--dorsal third MCP joint. Diagnostic nerve block of right dorsal antebrachial cutaneous nerve and right common radial nerve failed to relieve the pain. Eventually dorsal branch of the ulnar nerve was identified (as a small fascicular bundle separating from the distal ulnar nerve then passing dorsally around the ulna deep to the flexor carpi ulnaris) and specifically blocked with a small volume of local anesthetic resulting in complete resolution of pain. Lack of ulnar nerve block was confirmed by spared sensation over ventral hand.

Fixation for metacarpal neck fracture: a biomechanical study.

There is no robust evidence of the best operative treatment for displaced unstable metacarpal neck fractures. Numerous constructs are used in the fixation of metacarpal neck fractures. Currently, two common methods are dorsal locking plate and K-wire fixation. A new metacarpal sled fixation system for metacarpal neck fracture was designed to provide fracture stability but limit dissection and avoid exposed hardware. The purpose of this study was to compare the biomechanical integrity of the metacarpal sled versus standard locking plate fixation and retrograde K-wire fixation in a simulated porcine metacarpal fracture model. Transverse metacarpal neck fractures were created in 30 porcine second metacarpals. The specimens were randomly fixed with locking plates, metacarpal sleds, or retrograde K-wires. Constructs were then loaded to failure in three-point bending. Stiffness and peak load were measured from the load-to-failure deflection curve. Data were analyzed via ANOVA, followed by Tukey-Kramer's post hoc pairwise comparison. The K-wire group had the highest initial stiffness followed by the sled group and then the plate group. Statistical difference was only found between K-wires and plate. Peak load for the K-wire group was lowest, followed by sled, and then by plate. A statistically significant difference was observed between the peak loads of the K-wires and plate, as well as the sled and plate. However, a difference in peak load was not detected between the K-wires and sled. For transverse metacarpal neck fractures, a metacarpal sled construct provides similar fixation to K-wires with limited dissection and without exposed hardware or the potential for soft tissue tethering. The new low profile construct using a minimally invasive technique would be suitable for unstable metacarpal neck fractures.

Operative treatment of metacarpal and phalangeal fractures in athletes: early return to play

Background Evaluating the outcomes of operative treatment for metacarpal and phalangeal fractures in athletes returning early to play and discussing the more effective methods that permit rapid early return to athletic activity.Methods We retrospectively identified a total of 105 metacarpal or phalangeal fractures in 105 athletes with conservative or operative treatment in our department. Of these, 20 athletes required an early return to sport because of a pending important game in their competition within 1 month after injury. Therefore, they underwent surgical treatment with open reduction and internal fixation of metacarpal or phalangeal fractures in an attempt to achieve an early return to their chosen sport at their usual competitive level. The patients included 6 rugby football players, 2 soccer goalkeepers, 3 American football players, 3 handball players, 2 baseball players and 4 who participated in other sports. The clinical records of preoperative and postoperative radiographs were available for all patients, and clinical outcome was evaluated by total active motion (TAM).Results The patients were followed up for a mean of 27 (24–43) months. At the latest follow-up examination, bone union was obtained in all cases. In cases with metacarpal and phalangeal fractures, the average TAM was 263° (range 240°–270°).Conclusion We consider that an early comeback to training and competition can be permitted exclusively for patients with metacarpal and phalangeal fractures. It is important for the attending physician to administer such treatment after obtaining informed consent and develop a trusting relationship with the patient and other related individuals while paying attention to their hope of quick recovery.

Return to Play Following Metacarpal Fractures in Football Players

Objectives:Injuries involving fractures of the metacarpals are common among football players of all levels. These injuries are typically treated conservatively with casting or splinting among non-in-season athletes, a method that involves a relatively lengthy recovery time (four weeks). To our knowledge, there are no previous reports documenting return to play in elite football players after operative management of metacarpal fractures. The purpose of this study was to retrospectively review and describe the results of operative treatment of metacarpal shaft fractures in 19 high level football players with respect to return to play. We hypothesized that in-season football players with metacarpal fractures treated surgically would be able to return to play more quickly than the typical recovery time following non-operative treatment.Methods:Surgically treated metacarpal fractures in elite football players were queried over a three-year period (2009-2012) from a database maintained by American Sports Medicine Institute (ASMI) in Birmingham, AL. Over the study period, 19 football players were identified who underwent open reduction internal fixation of metacarpal fractures by one of three attending surgeons. Retrospective chart review and phone interviews with the patient and their athletic trainers were performed to identify player position, level of competition, mechanism of injury, return to play, post-operative bracing, and re-fracture event. Radiographs were used to classify the fractures, and operative reports were reviewed for implant choice. Numerical means were calculated for in-season return to play as well as for brace time.Results:Ten high school players (53%) and nine college players (47%) were injured. The most common injured positions were wide receivers and defensive backs (26% each). Most injuries occurred through player to player contact (63%) at a game (37%) or practice (47%). The long finger (58%) was the most commonly involved metacarpal. Two players (11%) had multiple metacarpal fractures. The most common location was mid-diaphyseal (74%). Twelve patients were stabilized with plates and screws, five of whom underwent lag screw augmentation. Six patients were stabilized with a metacarpal nail and one was stabilized with only lag screws. All athletes were able to return to their pre-injury level of play without recurrence of fracture. Return to play for in-season athletes (N=11) was 6.3 days. The average time to return to play for in-season high school football players (N=6) was 9.2 days and 2.8 days for in-season collegiate football players (N=5). All in-season athletes returned to play with protective equipment in the form of a padded glove, bivalve padded cast, padded club cast, or padded splint. The protective equipment was used for an average of 21 days.Conclusion:This study provides support for the surgical treatment of displaced metacarpal shaft fractures with immediate return to play as tolerated for in-season football players. No re-fractures or complications were identified with the use of a plate, nail, or with lag screws. Elite football players can return to play with or without protective bracing depending on the position played and within a week of operative fixation.

3D mini-plate internal fixation for treatment of metacarpal and phalangeal fractures: a short-term follow-up study

Objective To analyze the short term clinical results of 3D mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures.Methods Thirty-three patients with 35 metacarpal and phalangeal fractures were treated with open reduction and 3D mini-plate fixation via a dorsal approach.There were 20 metacarpal fractures and 15 proximal phalanx fractures.Functional exercise started 1 week after the surgery in patients with fracture fixation only,and 3 weeks postoperatively in patients with combined tendon repair.Results All the patients were follow-up for 3 to 9 months.There was no plate fracture.All the fractures healed uneventfully.There were no obvious angular or rotational deformities.Rated by the total active range of motion (TAM) system,finger functions were excellent in 18 cases,good in 14 cases and fair in 3 cases,with an overall satisfactory rate of 91.4％.Conclusion 3D mini-plate provides dual-plane,multi-faceted firm fixation of metacarpal and phalangeal fractures with displacement.It is particularly suitable for unstable fractures such as comminuted fractures and longitudinal fractures.It facilitates early functional exercise and is an ideal internal fixation method. Key words: Fracture fixation,internal; Metacarpal bones; Finger phalanges; Micro-plate

Functional results of osteosynthesis with mini-plate and screws in metacarpal fractures

ObjectivesTo evaluate the radiological and functional results of osteosynthesis with mini-plate and screws in metacarpal fractures. MethodsIn our study 43 patients who were operated between 2009 and 2012 were included. The patients were followed-up for (19.76±5.61) months. The mean age of patients was (31.11±7.81) years (7 females, 36 males). The fracture types were oblique for 19 patients, spiral for 15 patients and transverse for 9 patients. The patients were operated after a mean of 3.4 d (range 3 h-6 d) after the fracture had occurred. Patients were immobilized for 2 weeks with a splint after surgery. Passive joint movements were started on the third days, and active joint movements were started in the second week. Rehabilitation of all patients was done in the same center with supervision of the same physiotherapist. The patients were assessed by total joint range of movement of the finger, grasping strength and Quick-DASH scores. ResultsNo significant differences were detected between fingers of the operated hand with same finger of the healthy hand according to total joint range of movement. Total joint range of movement values were measured perfect for 38 patients, good for 4 patients and medium for 1 patient. There were no significant differences with the corresponding finger on the opposite healthy side according to grasping strength. Soiling in the wound dressing was observed in 1 patient but there was no active drainage. Soiling of the wound dressing disappeared after 3-5 d of treatment with antimicrobial agent. Bone union was observed in all patients in a mean of 6 weeks (range 5-7 weeks). The time to return to work was (31.6±8.9) d after the surgical treatment of the fracture. ConclusionsMini-plate and screws fixation of unstable metacarpal fractures produces anatomical reduction of fractures with stabilization that is rigid enough to allow early mobilization, thereby preventing stiffness and hence good functional results.

Plating of Metacarpal Fractures with Locked or Nonlocked Screws, a Biomechanical Study: How Many Cortices are Really Necessary?

Dorsal plate and screw fixation is a popular choice for metacarpal stabilization. The balance between construct stability and soft tissue dissection remains a surgical dilemma. Historically, six cortices of bone fixation on either side of a fracture were deemed necessary. This study aims to elucidate whether four cortices of locked fixation on either side of the fracture is equivalent to the current gold standard of six cortices of nonlocked fixation on either side of the fracture. If so, less dissection to insert shorter plates with fewer screws could be used to stably fix these fractures. With biomechanical testing-grade composite Sawbones, a comminuted metacarpal fracture model was used to test two fixation constructs consisting of a standard dorsal plate and either six bicortical nonlocking screws (three screws per segment) or four bicortical locking screws (two screws per segment). Thirty specimens were tested to failure in cantilever bending and torsion. There was statistical equivalence between the locking and nonlocking constructs in cantilever bending stiffness, torsional stiffness, maximum bending load, and maximum torque. The tested metacarpal fracture model had equivalent biomechanical properties when fixed with a standard dorsal plate and either six bicortical nonlocking screws or four bicortical locking screws. By utilizing fewer cortices of fixation, there will be less dissection and less soft tissue stripping during fixation of metacarpal fractures. This will also be of benefit in very proximal or distal fractures as multiple cortices of fixation are often difficult to obtain during stabilization of these challenging fractures.

Outcomes of Unstable Extraarticular Metacarpal Fractures Treated with Low Profile Titanium Plate System

Purpose: The purpose of this study was to evaluate clinical results for open reduction and internal fixation of unstable extraarticular metacarpal fractures using low profile titanium plates. Methods: Sixty-two consecutive patients (76 metacarpals) with unstable extraarticular metacarpal fractures who prospectively underwent internal fixation with plating were enrolled. Minimum follow-up was 1 year. There were 48 males and 14 females; average age was 39 years (range, 15-71 years). The location of the fractures was shaft in 65 metacarpals and the type was transverse in 22 cases, oblique in 46 cases, and communited in 8 cases. Of the 62 patients, 11 were open; 9 of these had additional soft tissue injury. The surgical outcome was assessed by clinical and radiographic outcomes and complications. Results: Bone union was successfully achieved in all patients on the average period of 6.4 weeks. The final range of total active motion was excellent for 64 cases, good for 6 cases, fair for 5 cases, and poor for 1 case. Postoperative complications occurred in 9 patients (15 metacarpals). Statistical analysis revealed that patient age, occupation, multiple metacarpal fractures, and soft tissue injury were significantly correlated with incidence of complications at last follow-up. Conclusion: Low profile titanium plating showed the low complication rate and good results in treating unstable extraarticular metacarpal fractures.

Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures

Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-dimensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm(2)) and subchondral volumes (mm(3)) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm(2); through the coronal plane arc (45°) was 129 mm(2), and through the sagittal plane arc (120°) was 265 mm(2). The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm(3). Mean subchondral volume occupied by the countersunk portion was 4%. The phalangeal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc. During coronal plane motion in neutral extension, the center of the base never engaged the dorsally located countersunk entry site. Metacarpal head surface area and subchondral head volume occupied by HCS were minimal. Articular surface area violation was least during the more clinically relevant sagittal plane arc of motion. The dorsal articular starting point was in line with the medullary canal and avoided engaging the center of the articular base through most of the sagittal plane arc. Three-dimensional computed tomography data support the use of an articular starting point for these extra-articular fractures.

Accuracy of fluoroscopy in the treatment of intra-articular thumb metacarpal fractures

The purpose of this study was to determine the accuracy of fluoroscopic imaging during closed reduction and percutaneous fixation of intra-articular thumb metacarpal fractures. Closed reduction and percutaneous fixation was assessed in eight simulated intra-articular thumb metacarpal fractures, using fluoroscopy and digital radiographs. Displacement and fracture step-off were measured during fluoroscopy, on plain radiographs, and by direct visualization after careful dissection. Displacement on fluoroscopy was 0.8 (SD 1.0) mm and 1.2 (SD 1.4) with radiographic imaging. Direct visualization showed displacement of 0.9 (SD 1.2) mm. Intra-articular step-off on fluoroscopy was 0.8 (SD 1.0) mm and 0.8 (SD 0.8) with radiographic imaging. Direct visualization showed an intra-articular step-off of 0.8 (SD 1.2) mm. Statistical analysis showed excellent compatibility between fluoroscopy and direct visualization. Fluoroscopic visualization during surgery provides an adequate assessment of articular step-off and displacement in comparison with radiographs and direct visualization.

Safety and efficacy of a new tourniquet system

BackgroundIn upper limb surgery, the pneumatic tourniquet is an essential tool to provide a clean, bloodless surgical field, improving visualization of anatomical structures and preventing iatrogenic failure. Optimal inflation pressure to accomplish these objects without injuring normal tissue and inducing complications is not yet established. Use of the minimum tourniquet pressure necessary to produce a bloodless surgical field is preferable in order to prevent injury to normal tissue. Various methods have been implemented in an effort to lower effective cuff pressure. The purpose of this study is to report clinical experience with a new tourniquet system in which pressure is synchronized with systolic blood pressure (SBP) using a vital information monitor.MethodsWe routinely used the tourniquet system in 120 consecutive upper limb surgeries performed under general anaesthesia in our operating room instead of our clinic. Cuff pressure was automatically regulated to additional 100 mmHg based on the SBP and was renewed every 2.5 minutes intervals.ResultsAn excellent bloodless field was obtained in 119 cases, with the exception of one case of a 44-year-old woman who underwent internal screw fixation of metacarpal fracture. No complications, such as compartment syndrome, deep vein disorder, skin disorder, paresis, or nerve damage, occurred during or after surgery.ConclusionsThis new tourniquet system, synchronized with SBP, can be varied to correspond with sharp rises or drops in SBP to supply adequate pressure. The system reduces labor needed to deflate and re-inflate to achieve different pressures. It also seemed to contribute to the safety in upper limb surgery, in spite of rare unexpected oozing mid-surgery, by reducing tissue pressure.

Combined Intramedullary and External Skeletal Fixation of Metatarsal and Metacarpal Fractures in 12 Dogs and 19 Cats

To report surgical technique, clinical experiences, and long-term outcomes of combined intramedullary/external skeletal fixation of metatarsal (MT) and metacarpal (MC) fractures in dogs and cats. Case series. Dogs (n = 12); 19 cats. Clinical and radiographic records of animals managed by combined intramedullary/external fixation of MT/MC fractures were reviewed. Signalment, fracture configuration, complications, and subjective clinical findings were recorded. Surgical technique involved retrograde intramedullary pin placement into fractured MT/MC bones, and transverse pin placement in the base of the MT/MCs or tarsal/carpal bones. Contoured pin ends were enshrouded dorsally in epoxy resin and implants maintained until fracture union. Postoperative clinical and radiographic reassessment was performed where possible. Small breed dogs (n = 12) and 19 cats were operated. Fixator removal occurred in < 10 weeks in all cases. Complications included synostosis (n = 2), pin tract discharge (7), excessive postoperative swelling (8), skin abrasions from the frame (2), and paw distortion associated with frame impingement (2). Long-term radiography documented degenerative changes associated with MT-phalangeal or MC-phalangeal joints in 2 dogs; 7 cats, but changes were typically graded mild or moderate and affected only 1 or 2 joints. Combined intramedullary/external fixation of MT/MC fractures is viable, particularly juxta-articular fractures. Pin penetration of MT-phalangeal or MC-phalangeal joints may cause morbidity and requires further study.

Ambulante Behandlung der Mittelhand- und Fingerfrakturen führt zu gleichen Resultaten wie eine stationäre Behandlung

Metacarpal and phalangeal fracture fixation may be conducted in ambulatory or inpatient settings. However, to date, little is known about the outcomes of the surgical treatment of metacarpal and phalangeal fractures in the two population groups. The aim of this study was to compare the surgical outcomes of patients undergoing treatment for metacarpal and phalangeal fractures in the ambulatory setting as compared to those in in-hospital settings. All patients who were surgically treated for metacarpal and phalangeal fractures at our institution were enrolled in this study. All patients treated non-surgically, as well as those who had sustained open fractures, were excluded from the study. A total of 85 patients met our inclusion criteria. Based on the length of hospital stay, patients were divided into two groups: inpatient (> 24 hours) and outpatient (< 24 hours). Fifty-three out of the eighty-five patients were available for follow-up examination. Patients were re-evaluated at a mean 17.9 months (range: 4-48 months; SD = 10 months) after surgery. Physical function in everyday life and specific hand function were compared between the groups using the DASH and Cooney outcome questionnaires. Range of motion of the affected side was measured using a standard goniometer and was evaluated as a proportion of total active motion (% TAM) relative to the contralateral uninjured side. Complication rates were calculated and compared between groups. There were no differences for the DASH outcome scores for phalangeal and metacarpal fractures on comparing both groups. There was also no statistically significant difference for the mean Cooney score for phalangeal fractures in both groups. The inpatient group had a significantly higher mean Cooney score (mean: 93.5; range, 70-100; SD 8.8; 95 % CI = 87.2, 99.8) after metacarpal fracture fixation than the outpatient group (mean: 82.5; range: 55-100; SD 14.5; 95 % CI = 75.3, 89.7) (p = 0.01). There was no statistically significant difference on comparing the mean proportion of total active motion (% TAM) relative to the contralateral uninjured side between the inpatient and outpatient groups (p > 0.05). The overall complication rate was 20.7 % (n = 11). The most common complication was postoperative infection with six cases (three inpatients; three outpatients). Outpatient surgical treatment of metacarpal and phalangeal fractures results in similar outcomes compared to inpatient treatment. Outpatient treatment of metacarpal and phalangeal fractures should be considered whenever possible.

Treatment of unstable metacarpal fractures by miniplate and screws

Abstract The goals of this study are to evaluate usefulness of open reduction and internal fixation with miniplate and screws in unstable metacarpal fractures. In the series 24 patients (23 males and 1 female), with mean age of 26 years (range: 18-34 years) were having unstable metacarpal fractures, treated with miniplate and screws. Clinicoradiological follow-up after surgery was done at 4, 6 and 8 weeks and monthly for next 6 months. Metacarpal fractures were predominantly seen in the dominant hand. The second metacarpal is the commonest site with male preponderance. Results were assessed in terms of union at fracture site and it was found that all metacarpal fractures were united clinicoradiologically with good functional recovery. In 6 cases implants were removed after 8 months. Twenty patients were followed up for 8 months, none developed infection or deformity or restriction of movements of fingers while 4 patients did not turn up for follow-up after 8 weeks. The results of this procedure were highly encouraging. Fixation of unstable metacarpal fracture with miniplate and screws is a demanding procedure. This procedure provides rigid and stable fixation, achieves anatomical reduction, early mobilization and restoration of functions.

Re-operation for tendon adhesions following open reduction and internal fixation of metacarpal fractures

Re-operation for tendon adhesions following open reduction and internal fixation of metacarpal fractures

Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. The present study compared results between locking plates and intramedullary K-wires. The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks' immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level IV continuous prospective comparative study.