Unstable Metacarpal Fractures Research Articles

Percutaneous transverse pinning for metacarpal fractures: a clinical trial

IntroductionMetacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure.MethodsBetween March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05.ResultsThe mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory.ConclusionPercutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale.Level of evidenceII, prospective cohort study.

Comparative Study between Kirschner Wire versus Mini Plate in Management of Unstable Metacarpal Fractures

Comparative Study between Kirschner Wire versus Mini Plate in Management of Unstable Metacarpal Fractures

Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block, in Internal Fixation of Unstable Metacarpal and Phalangeal Fractures of the Hand: A Comparative Study

Hand fractures are a common injury in emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization is necessary. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as a local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis. The purpose of the study is to compare the functional assessment of the hand function during a period of three months after surgical intervention for unstable metacarpal and phalangeal fractures under WALANT versus Biers block. Material &amp;Methods: Between May 2021 to October 2022, 43 patients with unstable metacarpal and phalangeal fractures underwent open reduction and internal fixation, 21 cases with Biers block(BB) anesthesia and rest with WALANT technique. Metacarpal fractures appeared in 29 cases and phalangeal fractures in 14 patients. Patients were operated within the first week from the injury. According to implants they employed locking plates, screws and Kirschner wires in two groups. Results: At three months postoperatively, Quick Dash Score is better in WALANT group while patients’ satisfaction does not differ between two groups. In WALANT group immediate postoperative median VA Score appeared 2/10, while in the Biers block group appeared 6/10. Patients which underwent WALANT technique were discharged on the same day after operation, while the patients with regional anesthesia the next postoperative day. Mean duration of analgesic use was sorter in WALANT group (2,3 days) than in BB group (5,7 days). Conclusion: Οbjective of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization and enhance hand functionality to avoid stiffness and tendon adhesions. Wide Awake local anesthesia no tourniquet technique is an alternative sedative procedure which immediately offers postoperative numerous advantages (low-cost technique, no complication from tourniquet, decrease sensation of intra or postoperative pain) compared with Bier’s block anesthesia. Based on our results we believe that WALANT technique offers many benefits in surgical treatment of hand fractures and is suggested as first choice anesthesiologist procedure.

Comparative study between bouquet technique and transverse wires in management of unstable metacarpal fractures

Comparative study between bouquet technique and transverse wires in management of unstable metacarpal fractures

Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases.

The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures. This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients. Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6weeks as compared with that noted in the unaffected side. The gas cavity upon H2 gas formation was first observed approximately 2weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery. Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.

Intramedullary K-wires versus Alternate Techniques for Metacarpal Shaft and Neck Fractures: A Systematic Review and Meta-analysis

Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/quickDASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time (p = 0.04; mean difference = − 13; 95% confidence interval = −26 to −0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.

Percutaneous Retrograde Technique Using Intramedullary Headless Compression Screws for Metacarpal Fractures Under Wide-Awake Local Anaesthesia No Tourniquet.

Background The common modality of treatment of metacarpal fractures is nonsurgical. There are, however, a subset of patients and fracture types that require surgical correction, but surgery comes with its own problems like stiffness and scarring. Therefore, surgical operations must be minimally invasive barring complications of anaesthesia and the procedure. Therefore, we conducted this study to assess patient outcomes following treatment with percutaneous intramedullary screw fixation via the wide-awakelocal anaesthesiano tourniquet (WALANT) approach for unstable metacarpal fractures. Methodology We retrospectively analysed the records of 21 patients who received metacarpal fixations with headless compression screws at two district general hospitals in the United Kingdom from 2018 to 2020. We used wide-awake anaesthesia with 10 mL (1% lidocaine and 1 mL 8.4% sodium bicarbonate as a buffer) infiltrated around the superficial tissues on the dorsal aspect of the metacarpal bone, including the periosteum. The Jahss manoeuvre was used to reduce the fracture under the guidance of a mini C-arm. All patients had 3-mm Medartis cannulated compression screws (Medartis AG, Basel, Switzerland) (self-tapping) inserted retroactively using a 5-mm skin incision. The range of movement of the metacarpophalangeal joint was checked intraoperatively and shown to the patient for optimal postoperative rehabilitation. Patients underwent a two-week follow-up wound check and examination for pain (using the visual analogue scale (VAS)) or stiffness requiring physiotherapy. We used the Manchester-modified (M2) disability of the arm, shoulder, and hand (DASH) score to scrutinize the fracture union and the functional outcome of the hand. We also assessed the time to return to work. Results The study included 18 men and two women with a mean age of 22.6 years (range, 18 to 40). The fifth (n=16), fourth (n=4), and second metacarpals (n=1) were involved, and we saw transverse (n=10) and short oblique (n=11) fractures. Fractures healed in five weeks (range, four to six weeks). The mean M2 DASH score was 0.8 (range, 0 to 6), and mean total active motion was 240° (range, 230° to 260°). At the final follow-up, the mean extensor lag for the metacarpophalangeal joint was 5° (range, 0° to 15°), 7° for the proximal interphalangeal joint (range, 0° to 15°), and no lag at the distal interphalangeal joint. The average VAS score at the end of two weeks was 8/10 (range, 7 to 9). The average time for the return to daily activities was 2.56 weeks. We found no intraoperative complications in any of the patients. All patients went home on the same day postoperatively and gave feedback that their experience with WALANT was good to excellent. All patients had a good range of motion at the two-week follow-up, and the mean time to return to normal work was two to three weeks. The M2 DASH score measured was satisfactory. Conclusions This retrospective study assessed patient outcomes following treatment with percutaneous intramedullary screw fixation via the WALANT approach for unstable metacarpal fractures. WALANT was a quick and reliable alternative to fix unstable metacarpal fractures, especially for high-demand patients requiring a short recovery period before returning to regular activity.Further research with a larger sample size and a longer follow-up to analyse the outcome is warranted before an actual guideline can be established.

Bouquet technique in management of unstable metacarpal fractures

Bouquet technique in management of unstable metacarpal fractures

A prospective study to evaluate the functional outcome of metacarpal shaft fracture treated with mini plates

Background: Metacarpal fractures are among the most common fractures of the hand. They may lead to loss of function if treated improperly. These injuries can be treated conservatively. However, if significant shortening, rotational deformity and angulation occur, surgical treatment is required. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using miniplates and screws as compared to the conservative treatment or K –wire fixation. Hence the study aims to assess the functional outcomes of patients with metacarpal fractures, who will be undergoing open reduction and fixation with low profile titanium plates in our department.Materials and Methods: Patients coming to the Department of Orthopaedic, at Sri Siddhartha MedicalCollege, Tumakuru with metacarpal shaft fractures who are treated with open reduction and internal fixation with mini-plate. All patients are operated in supine position and under infraclavicular block or general anesthesia. After the tourniquet is inflated, the forearm is placed in pronation, a dorsal longitudinal incision is made and the fracture is exposed with adequate soft tissue dissection. A low profile 2.0 mm titanium miniplate is applied with four screws, two on each side of the fracture. In oblique or spiral type of fractures, initially fixed with inter fragmentary screws and then by plate. Metacarpal alignment and angulation will be confirmed with fluoroscopy. The plate and screws was covered with periosteum and soft tissues.Results: The maximum subjects had injury on the right side (58.3%) and commones tbone to be involved was fracture of shaft of 5th metacarpal (37.5%). Transverse type (39.6%) was the commonest fracture pattern. Our study showed excellent functional outcome (54.2%) with lower complication rates and bone union was seen in minimum 6 weeks. Mean DASH score at 1 month (18.56), 3 month (11.56),6 months(3.02) with p value = 0.001.Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results. Detailed clinical and radiological assessment of fracture, careful preoperative planning, meticulous dissection, precision in surgical technique (coverage of plate with soft tissue) and choosing the correct implant (low profile plate) are critical in achieving good results and minimizing the complication.

New Linked-Wire-Type External Fixator (the Ichi-Fixator System) for Metacarpal Fractures: Case Series and Literature Review.

Background: External fixator is an effective treatment option in the comminuted or unstable metacarpal fractures. The new linked-wire type of external fixator (the Ichi-Fixator System) developed for hand and wrist fractures enables fine adjustment of the fixation under fluoroscopic inspection through small screws inside the fixator fitted externally. This technique is designed to reinforce the stability and rigidity of conventional percutaneous Kirchner wire fixation. The aim of this study is to assess the effectiveness of the fixator for comminuted or unstable metacarpal fractures through the evaluation of short-term results in ten cases. Methods: Patients were fixated with fixator pins and metal clamps using the Ichi-Fixator System. All patients were then examined for post-operative complications, functional recovery, visual analogue scale (VAS) score, and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score at the end of the final follow-up consultation. Results: Operative treatment using the Ichi-Fixator System facilitates anatomical reduction and allows immediate full mobilization, producing good outcomes. No infections were observed in all cases, including those at pin insertion sites. There were no implant failure and nonunion. Patients could perform all routine activities with normal grip strength and retained a full range of hand motion without pain. This treatment method with improved postoperative comfort would allow immediate return to work, which would clearly boost patient satisfaction. Conclusions: Ichi-Fixator System is considered to be useful for the treatment of metacarpal fractures, and this will provide a new surgical option for all hand fractures.

Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center. This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis. Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient. Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures.

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33years (range 18-61) in the IHCS group and 32years (range 17-68) in plate group. All patients were followed up for 1year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures.Level of evidence: I.

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.

Clinical Outcomes of Ready-Made J-Shaped Nail Fixation for Unstable Metacarpal Fractures.

Background: The purpose of this study was to report the clinical outcomes of ready-made J-shaped intramedullary nail fixation for unstable metacarpal fractures. Methods: A total of 25 unstable fractures from 24 patients were evaluated in this retrospective study, comprising 20 metacarpal neck and 5 metacarpal shaft fractures. The mean follow-up was 22 weeks. Functional outcomes were assessed based on the range of motion of the metacarpophalangeal joint. Radiographic outcomes were evaluated by four projections of the postoperative plain radiographs at the final follow-up, and then were rated as excellent if projections at the fracture site showed no correction loss or angular deformity greater than 10°. Surgery time and complications during the treatments were recorded for each case. Results: All 25 fractures obtained bony union. The mean range of motion of the metacarpophalangeal joint was 78° (range, 45°-90°). Radiographic outcomes were excellent in 24 (96%) of 25 fractures. Only one fracture had correction loss. The mean surgery time was 29 minutes (range, 14-61 minutes). Two cases had extensor tendon adhesion at the insertion site, which was easily released when the implant was removed. Conclusions: This study demonstrates that intramedullary fixation with a ready-made J-shaped nail is a reliable treatment option for unstable metacarpal fractures.

Comparative Study between Kirschner Wires and Mini-Set Plate in Management of Unstable Metacarpal Shaft Fractures

Metacarpal fractures comprise between 18–44 % of all hand fractures. Non-thumb metacarpals account for around 88 % of all metacarpal fractures, with the fifth finger most commonly involved. This is a comparative study between Kirschner wires and mini-set plate in management of unstable metacarpal shaft fractures. This is a review article, The search was performed in MEDLINE, Embase, Pubmed and CINAHL Plus in the same date range with the following mediacl terms: “Kirschner wires; mini-set plate; unstable; metacarpal shaft; fractures.”, including articles from 2000 to 2019, K-wire fixation is simple to manipulate and without or with little damage on fracture blood supply, and has been used extensively. Since in the K-wire fixation there is no compression on the fracture, it is difficult to control the motions of the fingers. Stiffness resulting from tendon adhesions and joint contractures is the most common complication associated with hand fractures. Conversely, fractures that require mini-plate fixation but are treated without fixation or with inadequate fixation still lead to stiffness and are associated with an increased rate of nonunion and malunion. Kirschner wires are almost always used for temporary fixation and are removed after the early appearance of fracture callus on radiographs. Despite the availability of many options for fixation, percutaneous fixation using Kirschner wires is a good method for treatment of unstable ulnar four metacarpal fractures. We recommended this technique, which is more biological, technically easier, safe, cheap and rapid to perform with good functional outcome.

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

ABSTRACTBackground: Metacarpal fractures are usually managed by conservative methods, but using these conservative methods in unstable fractures usually showed poor results. Surgical intervention is recommended in this fracture types.Purposes: This study aims to assess the functional outcomes of plate fixation in metacarpal shaft fractures. The assessment was done by using Total Active Flexion score according to the American Society for Surgery of the Hand.Patient and Methods: This study was a prospective study conducted at Al-Hussein University Hospital in a period between April 2017 and November 2019. This study was conducted on a total of 20 patients diagnosed with displaced, irreducible, and unstable metacarpal shaft fractures. Miniplate and screws was used for the fractures fixation. The patient's ages varied from 20 to 50 years old.Results: The study was conducted on 20 patients, 10 patients were male (50%) and 10 were female (50%). The dominant hand was involved in 14 patients (70%). fracture union was seen in all patients. Most of them showed bone union between 8-12 weeks with an average 10 weeks. The total active flexion was measured and showed excellent scores in 14 patients, good scores in 4 patients, and fair scores only in 2 patients.Conclusion: mini-plate and screws is a good choice for unstable metacarpal fractures fixation. The use of mini-plate and screws provide rigid stable fixation which allows early hand movement and achieving good functional outcomes.Keywords: Metacarpal fractures; Mini-plate and screws; total active flexion score.

Functional evaluation of various surgical modalities in treatment of hand fractures

Background: “Hand fractures can be complicated by deformity from no treatment, stiffness from over treatment, both deformity and stiffness from poor treatment.” - Swanson. Fracture of metacarpal bone of the hand constituting between 14-28% of all visit to hospital following trauma by various means like assault, road traffic accidents, industrial accidents, agriculture accidents etc. Fracture of the bones of hand are among the commonest fracture in humans, but their management varies widely in the different regions of world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Among the spectrum of hand and wrist injuries, fractures of the wrist rank first in terms of frequency and morbidity, with an estimated incidence of 400 fractures per 100,000 inhabitants per year3. 3 Fracture healing in the hand is not an isolated goal; rather the functional result is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires, bicondylar plates and screws as compared to conservative treatment. Material and Method: The sample size of the study was 28 patient in 12 patient in k-wire group, 8 patient in jess group and 8 in plate group. The functional outcome was assessed by calculating Total active range of motion (TAM) as suggested by the American Society of Surgery of Hand. At every follow up TAM (total active range of motion) will be calculate as follows TAM= (Active flexion at MCP+PIP+DIP)-Extension deficit at MCP, PIP, DIP. Recovery was calculated as percent regained in motion compared to normal range of digital motion (260 degree). Result: Fracture healing in the hand is not an isolated goal; rather the functional result is paramount importance. JESS, Plating and K-wire comprised of 8, 8 and 12 subjects respectively. Mean age (in years) of the subjects in JESS group was 41.75±21.93 while the mean age of the subjects in plating and K-wire group was 39.12±20.18 and 43.83±21.84 respectively. 14.35, 21.4% and 17.9% of the subjects in JESS, Plating and K-wire group respectively were injured due to fall from height. Road traffic as mode of injury was reported in 14.3%, 7.1% and 25% of the subjects in JESS, Plating and K-wire group respectively. Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results.

Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: a prospective study.

We prospectively assessed clinical and radiological outcomes of locking plate fixation in treating unstable fractures in 11 metacarpals, 15 proximal phalanges, and eight middle phalanges in 34 consecutive patients from October 2011 to December 2016. Median length of follow-up was 14 months (range 12-24). The motion of finger joints, bony union, and complication rates were recorded. The median postoperative range of motion of the two interphalangeal joints and the metacarpophalangeal joint was 82% of the contralateral hands. Fractures in the three locations had significantly different recovery of the finger motion, with the best recovery for the metacarpal fractures. Closer distance between the plate edge and joint line was associated with a more limited range of the finger motion. The clinical outcomes approached an acceptable level at final follow-up. Finger stiffness is unavoidable after locking plate fixation of metacarpal and phalangeal fractures even with early hand therapy, with stiffness occurring in 10 out of 34 cases at the time of final follow-up 1 year after surgery. Level of evidence: II.

Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study.

Intramedullary cannulated compression screws have been introduced for the fixation of unstable metacarpal fractures. In the present study, this technique was compared with dorsal compression plating to evaluate its biomechanical performance in stabilizing metacarpal shaft fractures. In a first set of experiments, the biomechanical characteristics of the screws were analysed in an artificial bone model. In subsequent experiments, midshaft osteotomies were performed in human cadaver metacarpals, followed by plating or intramedullary screw osteosynthesis. The metacarpals were tested to failure in cantilever bending, following a stepwise increasing cyclic loading protocol. We found a significantly lower load at failure and a significantly lower number of cycles to failure in the intramedullary screw group, but both methods offered sufficient stability under these loads. With reference to published loads on the metacarpals during use of the hand, we conclude that intramedullary osteosynthesis yields sufficient strength and stiffness for early active motion. A difference in its fixation stability is noted compared with plate fixation, which may not be clinically relevant.

Treatment of unstable metacarpal fractures using transverse Kirschner-wire fixation technique

Background Several methods of fixing unstable metacarpal shaft fractures have been described. The aim of the study was to assess the clinical and radiological results of transverse Kirschner (K)-wire fixation technique for the treatment of unstable ulnar four metacarpal fractures. Patients and methods A prospective study was held between 2014 and 2016 at Benha University Hospital on 25 patients (22 males and three females) who had unstable metacarpal fractures affecting second to fifth metacarpals treated with transverse wiring technique. The patients’ mean age was 30.9 years. The dominant hand was affected in 21 patients, whereas in four patients, the nondominant hand was affected. Under fluoroscopy, closed reduction and percutaneous fixation with three K-wires, one proximal and two distal to the fracture site, was done. The mean operative time was 28.8 min. The inclusion criteria included patients with acute metacarpal shaft fracture with unaccepted shortening, angulation, and rotation. Results The mean follow-up period was 12.1 months. Bony union was achieved at an average of 6.8 weeks. At the final follow-up, all patients had almost full range of motion, with a mean total active range of motion of 260° (245–270°). None of the patients had any clinically detectable rotational deformity, and the functional outcome was satisfactory, with mean grip strength of the injured hand of 97% in comparison with the noninjured side. The average Quick Dash score was 1.5±1.6, ranging from 0 to 4.5 points. The mean visual analog score for pain was 0.92±1.1. All patients returned to their ordinary jobs and were cosmetically and functionally satisfied with the results of their surgery. Two patients presented with superficial pin-tract infection and one patient united with 15° radiological angulation of the fifth metacarpal without any functional affection. No other complications occurred. Conclusion Transverse K-wire technique is an effective, easy, and safe method for treating unstable metacarpal fractures, without significant complications.