Treatment Of Metacarpal Neck Fractures Research Articles

Comparative Analysis of the Results of Treatment for Metacarpal Neck Fractures in Children with Antegrade and Retrograde Kirschner Wire Fixation

Introduction. Among hand injuries, the proportion of metacarpal fractures is 9.6–40.0 %. Currently, there is no single approach to the treatment of children with such injuries.The aim is to determine the optimal method of surgical treatment of metacarpal fractures in children by comparative analysis of the results of antegrade and retrograde osteosynthesis with Kirchner spokes.Materials and methods. A prospective cohort study included 186 children with closed head fractures of the II–V metacarpal bones. The main group consisted of 103 children (55.38 %) who underwent antegrade osteosynthesis; the control group consisted of 83 children (44.62 %) who had needles retrograde. Local inflammatory changes were assessed on the 3rd and 7th days after surgery. The volume of active movements in the metacarpophalangeal joints was measured after 3, 6 and 12 weeks.Results. At week 3 of follow-up, the median amplitude of movements in the metacarpophalangeal joints in patients of the main group was 18 [13; 26] degrees, in the control group — 7 [4; 9] (p < 0.001); at week 6–59 [49; 72] and 35 [32; 54] (p < 0.001) At week 12–89 [84; 90] and 82 [74; 86], respectively (p < 0.001). Macroscopic assessment of the needle insertion area on the 3rd day after surgery showed the absence of local inflammatory changes in 92 (89.3 %) and 73 patients (88.0 %) of the main and control groups (p = 0.953); on day 7, in 100 (97.1 %) and 76 (92.5 %), respectively (p = 0.497), however, the differences were not statistically significant.Discussion. The optimal way to treat metacarpal fractures in children should be technically simple and low-traumatic. The importance of early rehabilitation for restoring the volume of movement in the joints of the hand is confirmed by many studies.Conclusion. Due to the minimization of damage to the articular surfaces and the early start of rehabilitation, the best functional results were achieved in the antegrade osteosynthesis group.

Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases.

Objective The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type). Methods Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018. Results The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5 th , 3 rd , and 2 nd (n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30° for the 2 nd and 3 rd metacarpals and > 40° for the 5 th metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240° and returned to their former occupations. All fractures consolidated and there were no reinterventions. Discussion The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost. Conclusion This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.

Closed Reduction and Immobilization of Pediatric Fifth Metacarpal Neck Fractures.

There is no clear consensus for the criteria for closed treatment of metacarpal neck fractures. Our objective was to determine whether closed reduction of pediatric fifth metacarpal neck fractures results in a clinically meaningful improvement in radiographic angulation. We performed a retrospective cohort study of pediatric patients with fifth metacarpal neck fractures treated with closed reduction. Radiographs were examined for sagittal fracture angulation measured post-reduction, 2 to 14 days post-reduction, and 21 to 35 days post-reduction. We compared the angulation for open versus closed physes, initial fracture angulation greater than or less than 50°, and immobilization in extension versus intrinsic-plus position. Fifty-four subjects were included with an average age of 14.8 years at the time of injury and a mean initial fracture angulation of 42.7°. The improvement in fracture angulation was 8.3° (90% confidence interval [CI], 5.9-10.7) on post-reduction radiographs, 8.5° (90% CI, 6.1-10.9) at 2 to 14 days post-reduction, and 4.3° (90% CI, 1.4-7.2) at 21 to 35 days post-reduction. Subgroup analysis showed that patients with injury angle greater than or equal to 50° had significantly higher mean reductions than those with injury angle less than 50°. In this group, angulation improved 15.6° (90% CI, 8.5-22.7) post-reduction, 15.1° (90% CI, 10.1-20.1) at 2 to 14 days post-reduction, and 16.5° (90% CI, 10.4-22.6) at 21 to 35 days post-reduction. Closed reduction of pediatric fifth metacarpal neck fractures with initial fracture angulation less than 50° may not meaningfully improve sagittal alignment. For fractures with initial angulation greater than or equal to 50°, closed reduction resulted in clinically important, statistically significant, and lasting improvements of 16.5°.

Fixation of fifth metacarpal neck fractures: a comparison of medial locking plates with intramedullary K-wires.

Surgical treatment for metacarpal neck fractures may be indicated for malrotation, palmar angulation exceeding 30° or metacarpal shortening exceeding 3 mm, although these thresholds have not been firmly established. In a retrospective study, we compared the clinical and radiographic results of 54 patients with displaced fifth metacarpal neck fractures who were treated with either medial locking plates (14 patients) or retrograde intramedullary K-wires (40 patients). At a mean follow-up of 26 months (range 12 to 62), metacarpal shortening and angulation were 2 mm greater and 4° greater, respectively, in the K-wire group. The plate group had an earlier return to work and greater aesthetic satisfaction, but operative time and complication incidence were higher. Range of motion, time to union, grip strength and Quick Disability of the Arm, Shoulder and Hand scores were similar. We conclude that medial plating offers no clear advantage over K-wire fixation in treating metacarpal neck fractures. Level of evidence: III.

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Introduction When dealing with metacarpal neck fractures, the aim of treatment should include clinical and radiological objectives. The aim of this study was to assess the efficacy of flexible stable intramedullary nailing for the management of metacarpal neck fractures.Materials and Methods A total of twenty four patients (22 males and 2 females; mean age: 28.2 ± 7.7 years) with metacarpal neck fractures (second in 7 patients and fifth in 17 patients) whether isolated or associated with other body injuries and managed by percutaneous flexible stable intramedullary nailing were reviewed for a retrospective case series. Personal interviews were conducted together with clinical and radiological assessments. The final results were recorded at the time of personal interviews.Results The mean duration of surgery was 19.3 ± 2.5 minutes. The mean time of radiological union was 5 ± 1.3 weeks. The mean postoperative active range of motion of the metacarpophalangeal joint was 102.4 ± 11 degrees. The mean supination power of the involved hand in comparison to the contralateral side was 97.8 ± 3.4%, whereas the pronation power percentage was 99.2% ± 1.6. The mean power grip percentage to the contralateral side was 96.4 ± 2.9%, whereas the mean percentage of the pinch grip was 96.1 ± 4.2%. The mean postoperative DASH (Disability of Arm, Shoulder, and Hand) score was 0.3 ± 0.5.Conclusion Percutaneous flexible stable intramedullary nailing for the treatment of metacarpal neck fractures has expanded the armamentarium of the orthopaedic surgeons as an easy, cost-effective technique overcoming all possible deformities and allowing early and reliable active rehabilitation.Level of Evidence This is a Type IV, therapeutic retrospective case series.

Comparison study of three fixation methods for the treatment of the fifth metacarpal neck fractures

Objective To compare the clinical efficacy of closed reduction Kirschner wire transverse fixation, open reduction Kirschner wire cross fixation and open reduction plate screw fixation in the treatment of the fifth metacarpal neck fractures. Methods From March 2010 to January 2017, 83 patients with fresh closed fifth metacarpal neck fractures were treated by closed reduction Kirschner wire transverse fixation (34 cases as group A), open reduction Kirschner wire cross fixation (22 cases as group B) and open reduction plate screw fixation (27 cases as group C). According to the operation time, the number of C-arm fluoroscopy, complications, joint function recovery, grip strength and patient satisfaction, the efficacy of the three surgical methods was evaluated comprehensively. Results All the 83 patients were follow-up for 7 to 33 months with an average of 16.5 months. All the fractures achieved anatomical reduction and bone healing. At the last follow-up, there were no significant differences in grip strength, fracture healing time, complications and C-arm fluoroscopy frequency among the three groups (P>0.05). The operative time between group A and group B, group A and group C were significantly different (P 0.05). According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 27 cases, good in 4 cases and fair in 3 cases with the excellent and good rate being 91.2% for group A; the results were rated as excellent in 15 cases, good in 5 cases and fair in 2 cases with the excellent and good rate being 90.9% for group B; the results were rated as excellent in 16 cases, good in 7 cases and fair in 4 cases with the excellent and good rate being 85.2% for group C. Conclusion The application of closed reduction Kirschner wire transverse fixation in the treatment of fresh closed fifth metacarpal neck fractures has the advantages of easy operation, short operation time, stable fixation, little joint and tendon irritation and allowing early functional exercise. It has satisfactory efficacy and is worthy of clinical promotion. Key words: Metacarpal bones; Fractures,bone; Comparative study; Kirschner wire; Plate

Comparison of the clinical efficacy of close reduction internal fixation with intramedullary pin and cross Kirschner wires for the treatment of metacarpal neck fractures

Objective To compare the clinical efficacy of close reduction internal fixation with intramedullary pin and cross Kirschner wires in the treatment of metacarpal neck fractures. Methods From March 2013 to March 2016, 85 cases of metacarpal neck fractures were treated in our hospital. Close reduction internal fixation with intramedullary pin was conducted in 49 cases (intramedullary pin group) and with cross Kirschner wires in 36 cases (Kirschner wire group). Both groups were performed by the same surgeon. After the operation the same functional exercise instruction was given. The hand function was evaluated by the TAFS system issued by American Hand Surgery Association 10 months after the operation. Results All the patients were follow-up for 10 to 16 months with an average of 12 months. The fracture healing time was 10 weeks in one case from each of the two groups, and 6 to 8 weeks in the other 83 cases. The average healing time was (6. 2 +2. 4) weeks from the intramedullary pin group and (6. 3 +1. 9) weeks from the Kirschner wire group. There was no significant difference in the healing time between the two groups (P>0. 05). TAFS scores of hand function were excellent in 39 cases, good in 7 cases, fair in 3 cases with the excellent and good rate being 93. 9% from the intramedullary pin group; while they were excellent in 16 cases, good in 14 cases, fair in 6 cases with the excellent and good rate being 83. 3% from the Kirschner wire group 10 months after the operation. The results from the intramedullary pin group were better than those from the Kirschner wire group. The difference was statistically significant (P<0. 05). Conclusion The close reduction internal fixation with intramedullary pin for the treatment of metacarpal neck fractures is a simple method with small trauma. It has little effect on hand function exercise after the operation. The score of hand function recovery is better than that of Kirschner wire group. Key words: Metacarpal bones; Fractures,bone; Fracture fixation, internal; Intramedullary pin; Cross Kirschner wires

Manual reduction and traction fixation for the treatment of metacarpal neck fractures under ultrasound-guided

To study clinical efficacy of manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided. From April 2013 to August 2016, 30 patients with metacarpal neck fractures were treated with manual reduction and traction fixation under ultrasound-guided, including 26 males and 4 females aged from 14 to 56 years old with an average of (25.6±1.6) years old, the courses of diseases ranged from 7 h to 5 d with an average of (2.7±0.6) d. Twenty patients were the fifth metacarpal neck fracture, 7 patients were the 4th and 5th metacarpal neck fractures, 3 patients were the second metacarpal neck fracture. Fracture healing, angle of bilateral head shaft angle and active range of metacarpophalangeal joints was measured, and DASH score was applied to evaluate function. Twenty-seven patients were followed up from 6 to 11 months with an average of(7.2±0.8) months. Fracture were healed from 5 to 8 weeks with an average of (5.6±0.4) weeks. The affected shaft angle was (15.1±1.8)°, and health head shaft angle was (13.5±2.8)°, while there was no significant difference (t=1.54, P>0.05). The affected range motion of metacarpophalangealjoint was(86.3±2.6)°, health active range motion of metacarpophalangeal joint was(91.8±1.6)°, and no significant difference between both side (t=1.16, P>0.05). DASH score was 4.3±1.5 at 7 months after operation. Manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided could dynamic observe fracture position in time, high patients' acceptability and is a feasible method for the treatment of metacarpal neck fracture.

Closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone for treatment of the fifth metacarpal neck fractures

Objective To investigate the surgical technique and clinical effects of closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone in the treatment of the fifth metacarpal neck fractures. Methods From May 2014 to December 2016, 15 cases of the fifth metacarpal neck fractures were treated by closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone. Internal fixators were removed 6 weeks after the operation followed by early postoperative functional training. Results Anatomical reduction or near-anatomical reduction was achieved in 13 cases. Mild angular deformity occurred in 2 cases. All the patients were follow-up for 2 to 3 months. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 13 cases, good in 2 cases. Conclusion Closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone for treatment of the fifth metacarpal neck fractures can achieve satisfactory clinical effects due to convenient operation, reliable fixation and low cost. Key words: Metacarpal bones; Fractures,bone; Fracture fixation, internal; Closed reduction

Modified Bouquet Technique for Treatment of Metacarpal Neck Fractures

Modified Bouquet Technique for Treatment of Metacarpal Neck Fractures

中手骨頚部骨折の予後について

中手骨頚部骨折の予後について