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Davies A, Haines S, Giddins G. Non-operative management of proximal phalanx spiral fractures: the use of elastic strapping to treat malrotation. J Hand Surg Eur Vol 2025; 50:421-423. [PMID: 39169765 DOI: 10.1177/17531934241265678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
This study assessed rotation control elastic strapping as a treatment for proximal phalanx spiral fractures in adults, with good clinical outcomes. This is a cheap, simple and reliable management technique that avoids potential operative complications.
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Affiliation(s)
| | - Samuel Haines
- Royal United Hospitals Bath, Combe Park, Bath, Avon, UK
| | - Grey Giddins
- Royal United Hospitals Bath, Combe Park, Bath, Avon, UK
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Gaio NM, Kruse LM. Closed Reduction Percutaneous Pinning Versus Open Reduction With Plate and Screw Fixation in Management of Unstable Proximal Phalangeal Fractures: A Systematic Review and Meta-analysis. Hand (N Y) 2025; 20:136-142. [PMID: 37599408 PMCID: PMC11653309 DOI: 10.1177/15589447231189762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Proximal phalanx fractures are common, with surgical fixation indicated for unstable fractures. Traditionally, closed reduction percutaneous pinning (CRPP) resulted in decreased stiffness and tendon irritation compared to open reduction internal fixation (ORIF). We hypothesized that more recent studies would have more similar outcomes to CRPP. The purpose of this study was to compare CRPP and ORIF in terms of range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and complications. METHODS Four electronic databases were queried from 2010 to present. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers performed a two-step review process to identify relevant articles. Patient demographics, total active motion (TAM), DASH, and complications were extracted. The methodological quality of each study included was assessed independently. Meta-analysis was performed for comparative trials. RESULTS Fourteen studies met inclusion criteria including four comparative studies: Thirteen studies included TAM. The weighted average TAM was 228 ± 34° for CRPP and 223 ± 32° for ORIF (P = .07 with 95% confidence interval (CI), -0.5 to 10.5). Seven studies evaluated DASH scores; weighted average was 8.2 ± 8.9 for CRPP and 11.7 ± 6.5 for ORIF (P < .01 with 95% CI, 1.8-5.2). Two studies directly compared CRPP to ORIF, favoring ORIF for both TAM with d = 1.07 and DASH with d = 0.23. Rates of tenolysis or hardware removal were higher for ORIF (P < .01). CONCLUSIONS New literature suggests more equipoise with regard to treatment of proximal phalanx fracture with CRPP versus ORIF. TYPE OF STUDY/LEVEL OF EVIDENCE Meta-analysis, Level II.
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Turna A, Stringer I, Jemec B, Anadkat M, Arize C, Nikkhah D. Non-operative management of metacarpal II-IV fractures: A retrospective study from a tertiary hand unit. J Plast Reconstr Aesthet Surg 2024; 97:174-181. [PMID: 39154530 DOI: 10.1016/j.bjps.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 08/20/2024]
Abstract
Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns. All records for 76 non-operative patients presenting with fractures of metacarpals II-IV to our tertiary centre in the year 2019 were retrospectively reviewed. Patients were treated with thermoplastic splinting or fibreglass casting with a rehabilitative exercise programme. Range of motion (ROM) of the Metacarpophalangeal (MCPJ), Proximal Interphalangeal (PIPJ), and Distal Interphalangeal joints (DIPJ), return to work time, and complications were assessed at 12 weeks post-treatment. Mean return to work time was 5.4 weeks, and patients did not report any serious adverse events; the main complication reported was tenderness on palpation (20%). The MCPJ exhibited the poorest ROM (9° flexion reduction relative to the healthy hand). Metacarpal II fractures were associated with significantly worse MCPJ flexion than metacarpal III (p = 0.022) and metacarpal IV (p = 0.049) fractures. Fractures of the metacarpal base were associated with superior MCPJ flexion (p = 0.004) but longer return to work time (p = 0.042) than head fractures. Spiral fractures were associated with shorter return to work time (p = 0.043) and superior ROM results (p = 0.041). In conclusion, outcomes of the non-operative treatment of metacarpal II-IV fractures are highly dependent on the location and pattern of the fracture, and this should be considered during clinical decision making.
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Affiliation(s)
- Adam Turna
- University College London Medical School, 74 Huntley St, London WC1E 6DE, United Kingdom.
| | - Immy Stringer
- University College London Medical School, 74 Huntley St, London WC1E 6DE, United Kingdom
| | - Barbara Jemec
- Toronto Western Hospital Hand Clinic, 399 Bathurst St., East Wing, 2nd Floor, Toronto, ON, M5T 2S8, Canada
| | - Meera Anadkat
- Department of Plastic and Reconstructive Surgery and Hand Therapy Unit, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
| | - Chinedum Arize
- Department of Plastic and Reconstructive Surgery and Hand Therapy Unit, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
| | - Dariush Nikkhah
- University College London Medical School, 74 Huntley St, London WC1E 6DE, United Kingdom; Department of Plastic and Reconstructive Surgery and Hand Therapy Unit, Royal Free Hospital, Pond St, London NW3 2QG, United Kingdom
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Bigorre N. Complications of osteosynthesis for long-finger metacarpal and phalanx fracture. HAND SURGERY & REHABILITATION 2024; 43:101746. [PMID: 38971225 DOI: 10.1016/j.hansur.2024.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/08/2024]
Abstract
Fractures of the metacarpals and phalanges represent a significant proportion of hand fractures. Although non-operative treatment is generally effective, some fractures require surgery. Historically, osteosynthesis using K-wires was widely used, but screw plates and then cannulated intramedullary screws have emerged as therapeutic alternatives. We assessed the complications associated with the different osteosynthesis techniques: stiffness, infection, bone consolidation and hardware-related problems. Each osteosynthesis technique has advantages and disadvantages, and choice depends on several factors. An individualized approach according to patient and fracture is essential to optimize clinical results.
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Affiliation(s)
- Nicolas Bigorre
- Centre de la Main - 47 Rue de la Foucaudière, 49800 Trelaze, France.
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Luo W, Wang Y, Wang Z, Jiao J, Yu T, Jiang W, Li M, Zhang H, Gong X, Chao B, Liu S, Wu X, Wang J, Wu M. Advanced topology of triply periodic minimal surface structure for osteogenic improvement within orthopedic metallic screw. Mater Today Bio 2024; 27:101118. [PMID: 38975238 PMCID: PMC11225863 DOI: 10.1016/j.mtbio.2024.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/02/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024] Open
Abstract
Metallic screws are one of the most common implants in orthopedics. However, the solid design of the screw has often resulted in stress shielding and postoperative loosening, substantially impacting its long-term fixation effect after surgery. Four additive manufacturing porous structures (Fischer-Koch S, Octet, Diamond, and Double Gyroid) are now introduced into the screw to fix those issues. Upon applying the four porous structures, elastic modulus in the screw decreased about 2∼15 times to reduce the occurrence of stress shielding, and bone regeneration effect on the screw surface increased about 1∼50 times to improve bone tissue regrowing. With more bone tissue regrowing on the inner surface of porous screw, a stiffer integration between screw and bone tissue will be achieved, which improves the long-term fixation of the screw tremendously. The biofunctions of the four topologies on osteogenesis have been fully explored, which provides an advanced topology optimization scheme for the screw utilized in orthopedic fixation.
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Affiliation(s)
- Wangwang Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tong Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Weibo Jiang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Mufeng Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Han Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Chao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Shixian Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xuhui Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Del Chiaro A, Suardi C, Nucci AM, Grassi A, Pfanner S, Poggetti A. Choosing the proper implant for extra-articular fractures of proximal phalanges: A study on 75 cases. Injury 2024; 55:111441. [PMID: 38430751 DOI: 10.1016/j.injury.2024.111441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Phalangeal fractures are the most common fractures of the hand and in particular the proximal phalanx of the long fingers is the most involved. These fractures can ben conservatively managed but, when the fracture pattern is considered unstable, surgical treatment is recommended. However, there is no consensus in literature about the proper surgical option for extra-articular proximal phalanx fractures. MATERIAL AND METHODS We compared clinical and radiographical results after treatment of 75 cases of extra-articular proximal phalanx fractures using three different surgical techniques: closed reduction and internal fixation (CRIF) with Kirschner wires (G1 group), open reduction internal fixation (ORIF) with plates and screws or lag screws (G2 group), and closed reduction and intramedullary screw fixation (CRIMEF)(G3 group). RESULTS We found no significant differences in term of union rate and time to fracture healing between the three groups. However, we found a significant reduction in time to return at work and in TAM at the final follow-up examination in G3 group (treated with CRIMEF) when compared with both G1 and G2. No differences in complications rate were found between three groups. DISCUSSION The surgical variability in the management of extra-articular phalanx fractures create lacks on standard guide for treatment. CONCLUSIONS In conclusion, our results showed good clinical and radiographical results with all the three surgical options. However, the closed reduction and internal fixation with intramedullary screws (CRIMEF) seems to be better in terms of time to return to work and TAM at the final follow-up, probably due to good primary stability and little risk of soft tissue adherence development.
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Affiliation(s)
- A Del Chiaro
- 1st Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, Pisa, IT, Italy
| | - Chiara Suardi
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy.
| | - A M Nucci
- Paediatric Orthopaedic and Traumatology Department, Meyer Children's University Hospital, University of Florence, 50139 Florence, Italy
| | - A Grassi
- 2nd Orthopaedic and Trauma Unit, IRCCS (Istituto Ortopedico Rizzoli), Via Di Barbiano, 1/10, Bologna, IT, Italy
| | - S Pfanner
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
| | - A Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Largo Palagi 2, Florence, IT, Italy
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Nessralla CJ, Ranganath K, Benavent KA, Zhang D, Earp BE, Blazar P. Risks of Reoperation in Surgically Treated Fractures of the Proximal Phalanx. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:169-172. [PMID: 38903843 PMCID: PMC11185887 DOI: 10.1016/j.jhsg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/05/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose The objective of this study was to determine the risk factors and the rate of reoperation after closed reduction percutaneous pinning (CRPP) of isolated closed single-digit proximal phalanx fractures. Methods A retrospective cohort study was conducted for patients who underwent CRPP of non-thumb closed proximal phalanx fractures between 2010 and 2020 at two level-I trauma centers and two community teaching hospitals. Demographics, fracture, and treatment characteristics were collected. The primary outcome measure was reoperation. Secondary outcome measures were complication and reoperation specifically for digital stiffness. Results Of the 115 patients who underwent surgical treatment, 46 patients (40.0%) had a complication and 13 patients (11.3%) underwent reoperation at a mean of 6.7 months-most of which (84.6%) were for digital stiffness. Conclusions Surgeons and patients may be aware that CRPP of closed extra-articular proximal phalanx fractures carries considerable rates of complication and reoperation. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Charles J. Nessralla
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | | | - Kyra A. Benavent
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Dafang Zhang
- Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Brandon E. Earp
- Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Philip Blazar
- Harvard Medical School, Boston, MA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
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Ho TY, Hsu CE, Wang WC, Ting YN, Tsai MT, Chiu YC, Hsu JT. Biomechanical study of the fixation ability of the dorsal and volar locking plate for transverse metacarpal neck fractures. Medicine (Baltimore) 2023; 102:e34981. [PMID: 37682204 PMCID: PMC10489259 DOI: 10.1097/md.0000000000034981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Metacarpal neck fracture is one of the most common types of hand fractures; the literature suggests that applying a bone plate on the dorsal side provides higher fixation strength than that provided by other fixation methods. However, bone plate fixation on the dorsal side may result in postoperative tendon adhesion. So far, no studies have investigated the fixation of metacarpal neck fractures on the volar side by using a bone plate. The objective of this study was to investigate the differences in the fixation results between bone plate fixation on the dorsal side and bone plate fixation on the volar side of the metacarpal in the case of a metacarpal neck fracture. A saw blade was used to create a transverse metacarpal neck fracture on 14 artificial metacarpal bone specimens. The specimens were divided into 2 groups depending on the fixation method: a volar locking plate (VLP) group and a dorsal locking plate (DLP) group. All specimens were subjected to a cantilever bending test on a material testing system, and a force-displacement curve was used to measure the yield force and stiffness, which served as an indicator of the fixation ability of the 2 fracture fixation methods. For the experimental results, the Mann-Whitney U test was used to compare the fixation abilities of the 2 fixation methods. In terms of yield force, the DLP group (266.9 ± 68.3 N) scored significantly higher than the VLP group (32.6 ± 2.7 N) (P < .05); expressed in terms of median, the DLP group scored 8.2 times higher than the VLP group. Similarly, in terms of stiffness, the DLP group (69.0 ± 13.4 N/mm, median ± interquartile range) scored significantly higher than the VLP group (12.9 ± 1.4 N/mm) (P < .05); expressed in terms of median, the DLP group scored 5.3 times higher than the VLP group. The fixation strength of volar bone plates is only about one-third of that of dorsal bone plates.
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Affiliation(s)
- Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung, Taiwan
| | - Wei-Chih Wang
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, China Medical University, Taichung, Taiwan
- School of Dentistry, China Medical University, Taichung, Taiwan
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Ma X, Wang L, Zhang X, Zhang Z, Xu Y, Lv L, Shao X. Comparative study of K-wire combined with screw vs. K-wire in the treatment of AO type B3.1 phalangeal fractures. BMC Musculoskelet Disord 2023; 24:591. [PMID: 37468856 DOI: 10.1186/s12891-023-06731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE The purpose of this study was to introduce the surgical method of K-wire combined with screw in the treatment of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type B3.1 phalangeal fractures and to compare its clinical, radiological and functional outcomes with K-wire fixation. METHODS This was a retrospective comparative study. From January 2015 to February 2022, we treated 86 patients with AO type B3.1 phalangeal fractures. A total of 71 patients were finally included in the statistical analysis. Thirty-nine patients received K-wires combined with screw, and 32 patients received simple K-wires. The follow-up time was at least 6 months. Outcome measures included general information, operative time, total active motion (TAM), pinch strength, radiological union time, pain assessed by visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, cost, and complications. RESULTS The follow-up time was 6-12 months, with an average of 7.9 months. All patients achieved clinical and radiological union. Compared with the K-wire fixation group, the TAM, radiological union time and VAS score of the K-wire combined with screw group had obvious advantages. Compared with the opposite healthy hand, the grip strength of the two groups was similar, and there was no significant difference in the QuickDASH score. The incidence rate of complications in the K-wire combined with screw group (2/39) was lower than that in the K-wire fixation group (7/32). CONCLUSIONS Compared with simple K-wire fixation, K-wire combined with screw in the treatment of AO type B3.1 phalangeal fractures is a safer and reliable surgical method. K-wire controls the rotation and plays a role similar to a "lock". The screw can exert pressure and fix it more firmly. It shortens the time of fracture healing and has a higher TAM and fewer postoperative complications.
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Affiliation(s)
- Xuelin Ma
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Wang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaoran Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhemin Zhang
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yali Xu
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Li Lv
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xinzhong Shao
- Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Cheng Y, Zou J, Wang C, Xing J, Zhao P, Gao M, Yang H, Zhang H. A comparison of treatment between mini T-plate and headless cannulated compression screw in calcaneal osteotomy. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05840-8. [PMID: 37249628 DOI: 10.1007/s00264-023-05840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE In clinical studies, we discovered that when using headless cannulated compression screw fixation, many patients complain of heel pain and frequently need to have the screws removed, whereas this occurrence is uncommon with plate fixation. This study aims to compare the clinical outcome of a mini T-plate and headless cannulated compression screws in calcaneal osteotomy. METHODS We reviewed the medical records of patients who had calcaneal osteotomy performed by one senior chief surgeon in our hospital between January 2014 and May 2021. Thirty-nine patients met the selection criteria: 22 were fixed using a mini T-plate through a modified small "L" incision on the lateral aspect of the calcaneus and 17 were fixed using double screws through an oblique incision on the lateral aspect of the calcaneus. Then, we compared the patient demographics, surgical statistics, and postoperative complications in calcaneal osteotomy between a mini T-plate and double 6.5-mm headless cannulated compressed screws. RESULTS Each patient attained radiographic union. The average age was 49.23±13.80 (range: 24-76) years and the average follow-up duration was 47.07±8.64 (range: 36-66) weeks. The average operation duration and times of intraoperative fluoroscopy were significantly lower in the mini T-plate group (P<0.05). There was a savings of $838.88 per patient when using double screws for fixation. The incidence of hardware-related pain and implant removal was lower in the mini T-plate group (P<0.05). There is no significant difference between the two groups in terms of delayed incision healing and clinical neurological complications (P>0.05). CONCLUSIONS In calcaneal osteotomy, the operation duration, times of intraoperative fluoroscopy, hardware-related pain, and implant removal rate were lower with mini T-plate fixation than with double screws fixation. Therefore, we consider that the mini T-plate would be a good alternative to double screws in calcaneal osteotomy.
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Affiliation(s)
- Yu Cheng
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China
| | - Jun Zou
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China
| | - Changbao Wang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China
| | - Junhui Xing
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University; Soochow University, Suzhou, Jiangsu, China
| | - Piqian Zhao
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University; Soochow University, Suzhou, Jiangsu, China
| | - Mingyang Gao
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China.
| | - Huiling Yang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China.
| | - Hongtao Zhang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University; Soochow University, Suzhou, Jiangsu, China.
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Henry TW, Tulipan JE, Kwan SA, Beredjiklian PK, Lutsky KF, Matzon JL. Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws. Hand (N Y) 2023; 18:48-54. [PMID: 33834886 PMCID: PMC9806528 DOI: 10.1177/15589447211003185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. METHODS All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. RESULTS Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. CONCLUSIONS Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.
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12
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Allen ST, Wang OJ, Erickson LO, Ward CM. Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures. Hand (N Y) 2023; 18:61-66. [PMID: 33834894 PMCID: PMC9806539 DOI: 10.1177/15589447211003181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. METHODS We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. RESULTS Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. CONCLUSIONS We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.
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Affiliation(s)
| | | | | | - Christina M. Ward
- University of Minnesota, Minneapolis,
USA
- Regions Hospital, Saint Paul, MN,
USA
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13
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Chiu YC, Hsu CE, Ho TY, Ting YN, Tsai MT, Hsu JT. Biomechanical study on fixation methods for horizontal oblique metacarpal shaft fractures. J Orthop Surg Res 2022; 17:374. [PMID: 35922799 PMCID: PMC9351190 DOI: 10.1186/s13018-022-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft fractures. MATERIALS AND METHODS Horizontal oblique metacarpal shaft fractures were created in 21 artificial metacarpal bones and fixed using one of the three methods: (1) two lag screws, (2) a regular plate, and (3) a locking plate. All the specimens were subjected to the cantilever bending test performed using a material testing machine to enable recording of the force-displacement data of the specimens before failure. The Kruskal-Wallis test was used to compare failure force and stiffness values among the three fixation methods. RESULTS The mean failure force of the two lag screw group (78.5 ± 6.6 N, mean + SD) was higher than those of the regular plate group (69.3 ± 17.6 N) and locking plate group (68.2 ± 14.2 N). However, the mean failure force did not significantly differ among the three groups. The mean stiffness value of the two lag screw group (17.8 ± 2.6 N/mm) was lower than those of the regular plate group (20.2 ± 10.5 N/mm) and locking plate group (21.8 ± 3.8 N/mm). However, the mean stiffness value did not significantly differ among the three groups. CONCLUSION The fixation strength of two lag screw fixation did not significantly differ from that of regular and locking bone plate fixation, as indicated by the measurement of the ability to sustain force and stiffness.
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Affiliation(s)
- Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan.,Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yen-Nien Ting
- 3D Printing Medical Research Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ming-Tzu Tsai
- Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan
| | - Jui-Ting Hsu
- Department of Biomedical Engineering, College of Biomedical Engineering, China Medical University, Taichung, 404, Taiwan. .,School of Dentistry, College of Dentistry, China Medical University, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 413, Taiwan.
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14
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Ahmad S, Gupta T, Ansari S, Jain A, Barik S, Singh V. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. Strategies Trauma Limb Reconstr 2022; 17:74-80. [PMID: 35990184 PMCID: PMC9357798 DOI: 10.5005/jp-journals-10080-1556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Various modalities of treatment have been used for the management of metacarpal and phalangeal fractures which include K-wire fixation, mini plates, lag screws fixation, intramedullary screw fixation and external fixator application. The aim of this study was to analyse complications and patient-related functional outcomes after antegrade or retrograde crossed intramedullary K-wire fixation of metacarpal and proximal phalangeal fractures. METHODS Thirty-one patients (36-fractures, 16-metacarpals, 20-proximal phalanx) meeting the study criteria were included in this prospective study. Fixation of the fractures was done by use of crossed intramedullary K-wire using the principles of 3-point fixation. RESULTS The mean preoperative angulation of the fractures noted in this study was 35.8° which was significantly reduced at final follow-up. Union was noted at a mean period of 4.2 ± 6.8 weeks. The mean range of motion at the metacarpophalangeal and proximal interphalangeal joint was 96.4% and 86.3%, respectively as compared to the opposite hand. Stiffness (n = 3, 14.2%) and persistent pain (n = 2, 9.5%) at the joints were the most common complications noted in this study. CONCLUSION Crossed percutaneous intramedullary fixation of small bone fractures of the hand is a versatile method with advantages such as cost-effectiveness and lesser operative time when compared to other modalities of fixation. Earlier range of motion (ROM) exercises can be started due to preservation of gliding planes, no surgical wound along with good fracture stability and minimal hardware impingement. HOW TO CITE THIS ARTICLE Ahmad S, Gupta T, Ansari S, et al. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. Strategies Trauma Limb Reconstr 2022;17(2):74-80.
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Affiliation(s)
- Sabeel Ahmad
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Tushar Gupta
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Sajid Ansari
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Aakriti Jain
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopaedics, AIIMS, Deoghar, Jharkhand, India
| | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India
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15
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Miles MR, Green T, Parks BG, Thakkar MY, Segalman KA, Means KR. Comparison of Lag Versus Nonlag Screw Fixation for Long Oblique Proximal Phalanx Fractures: A Biomechanical Study. J Hand Surg Am 2022; 47:476.e1-476.e6. [PMID: 34247847 DOI: 10.1016/j.jhsa.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/31/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare lag versus nonlag screw fixation for long oblique proximal phalanx (P1) fractures in a cadaveric model of finger motion via the flexor and extensor tendons. METHODS We simulated long oblique P1 fractures with a 45° oblique cut in the index, middle, and ring fingers of 4 matched pairs of cadaveric hands for a total of 24 simulated fractures. Fractures were stabilized using 1 of 3 techniques: two 1.5-mm fully threaded bicortical screws using a lag technique, two 1.5-mm fully threaded bicortical nonlag screws, or 2 crossed 1.14-mm K-wires as a separate control. The fixation method was randomized for each of the 3 fractures per matched-pair hand, with each fixation being used in each hand and 8 total P1 fractures per fixation group. Hands were mounted to a custom frame where a computer-controlled, motor-driven, linear actuator powered movement of the flexor and extensor tendons. All fingers underwent 2,000 full flexion and extension cycles. Maximum interfragmentary displacement was continuously measured using a differential variable reluctance transducer. Our primary outcome was the difference in the mean P1 fragment displacement between lag and nonlag screw fixation at 2,000 cycles. RESULTS The observed differences in mean displacement between lag and nonlag screw fixation were not statistically significant throughout all time points. A two one-sided test procedure for paired samples confirmed statistical equivalence in the fragment displacement between these fixation methods at all time points, including the primary end point of 2,000 cycles. CONCLUSIONS Nonlag screws provided equivalent biomechanical stability to lag screws for simulated long oblique P1 fractures during cyclic testing in this cadaveric model. CLINICAL RELEVANCE Fixation of long oblique P1 fractures with nonlag screws has the potential to simplify treatment without sacrificing fracture stability during immediate postoperative range of motion.
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Affiliation(s)
- Megan R Miles
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Tyler Green
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Brent G Parks
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Madhuli Y Thakkar
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Keith A Segalman
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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16
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Kibar B, Cavit A, Örs A. A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures. J Hand Surg Eur Vol 2022; 47:179-185. [PMID: 34107786 DOI: 10.1177/17531934211021521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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 33 years (range 18-61) in the IHCS group and 32 years (range 17-68) in plate group. All patients were followed up for 1 year. 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.
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Affiliation(s)
- Birkan Kibar
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Cavit
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Abdullah Örs
- Department of Anatomy, Kocaeli Üniversity, İzmit, Turkey
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17
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Ederer IA, von Fraunberg J, Kolbenschlag J, Nusche A, Daigeler A, Medved F. [Percutaneous, antegrade Pinning of proximal phalangeal Fractures: Comparison of Early Active Motion vs. Immobilization by Splinting]. HANDCHIR MIKROCHIR P 2021; 53:467-474. [PMID: 34583402 DOI: 10.1055/a-1559-2783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This retrospective study compares the functional outcome after early active postoperative motion with the outcome after 6 weeks of immobilization by splinting in patients with proximal phalangeal fractures treated by percutaneous, antegrade pinning. PATIENTS AND METHODS 46 out of 90 patients treated by closed reduction and percutaneous antegrade pinning of isolated fractures of the proximal phalanges were re-evaluated on average after 18.5 months. There were 17 women and 29 men with a mean age of 42.8 years. 28 patients underwent early active postoperative motion and 18 patients were immobilized by splinting for 6 weeks postoperatively. The two groups were statistically comparable with respect to age, gender, fracture localisation and morphology, mechanism of injury and operative time. Follow-up examination included measurement of active and passive range of motion (TAM; TPM) of the injured finger and the uninjured finger of the opposite side as well as grip strength of both hands. In addition, postoperative complications, the DASH-score and time interval between surgery and return to work were registered. RESULTS There were no significant differences between the two groups regarding rate of complication, number or required revisions, finger motion and grip strenght. Patients with early active motion returned earlier back to work than patients treated by postoperative splinting (2.5 vs. 9.0 weeks; p = 0.035). With 1.7 the DASH-score in the group with early active motion was better than in the splinting group with 2.5 (p = .269). CONCLUSION Patients with early active postoperative motion returned earlier back to work. There was no significant difference between both groups respecting global finger function.Compliant patients with a fracture of the proximal phalanx treated by closed reduction and percutaneous pinning can be treated with early active motion postoperatively.
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Affiliation(s)
- Ines Ana Ederer
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie.,Klinik für Plastische, Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus Frankfurt
| | - Johannes von Fraunberg
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie.,Eberhards Karls Universität Tübingen, Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde
| | - Jonas Kolbenschlag
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie
| | - Andreas Nusche
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie
| | - Adrien Daigeler
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie
| | - Fabian Medved
- BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen; Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie
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18
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Varitimidis S, Dailiana Z, Agorastakis D, Fyllos A, Zibis A, Hantes M, Malizos K. Long-Term Functional Results of Intra- and Extra-Articular Hand Fractures Treatment With Titanium Miniature Plates and Screws With Minimum Follow-Up of 24 Months. Cureus 2021; 13:e15438. [PMID: 34258109 PMCID: PMC8255029 DOI: 10.7759/cureus.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the long-term outcome of an extended range of hand fractures treated with titanium, low profile plates, and screws. Materials and methods This retrospective study included adult patients with at least one phalangeal and/or metacarpal fracture, treated with mini titanium plates and screws, between 2004-2016, in a single trauma center, that were followed-up for at least 24 months and with complete, intact medical records. Results 90 patients (79 men and 11 women) with 114 hand (46 phalangeal, 68 metacarpal) fractures fulfilled the inclusion criteria. Thirty-two fractures were open (28.07%), 27 were intra-articular (23.68%), and 12 were both open and intra-articular fractures. The mean age of the patients was 36.02 years (range 17-75). Mean follow-up was 95.3 months (range 24 to 138). Open fractures had a reduced mean grip strength and total active motion. No difference was observed between intra-articular and extra-articular fractures (for grip strength and total active motion). Predictors of the final outcome included the severity of the initial injury (open vs closed) and not the anatomic location (intra- or extra-articular, metacarpal, or phalangeal) of the fracture. Conclusions Low-profile plates and screws can successfully be used to establish union and restore the alignment of the fractured bone while achieving a satisfactory clinical outcome, even in cases of open or intra-articular fractures.
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Affiliation(s)
- Sokratis Varitimidis
- Orthopaedics and Musculoskeletal Trauma, Faculty of Medicine, University Of Thessaly, Larissa, GRC
| | - Zoe Dailiana
- Orthopaedics and Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, GRC
| | - Dimitrios Agorastakis
- Orthopaedics and Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, GRC
| | - Apostolos Fyllos
- Anatomy, School of Health Sciences, University of Thessaly, Larissa, GRC
| | - Aristeidis Zibis
- Anatomy, School of Health Sciences, University of Thessaly, Larissa, GRC
| | - Michael Hantes
- Orthopaedics and Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, GRC
| | - Konstantinos Malizos
- Orthopedics and Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Larissa, GRC
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19
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe treatment options for phalangeal fractures. 2. Choose an appropriate fracture management plan that optimizes patient goals and range of motion. 3. Describe closed and open reduction techniques of commonly encountered phalangeal fracture patterns. SUMMARY Phalangeal fractures are the second most common upper extremity fracture. Although many can be treated with splinting, operative intervention may be required for unstable fracture patterns and those involving the articular surface. Failure to appropriately treat these fractures can result in finger stiffness, loss in range of motion, and functional deficits. The type of fixation method can range from percutaneous pinning to open reduction and internal fixation. This article presents a series of cases to illustrate the appropriate management of phalangeal fractures using an evidence-based approach.
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20
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Guerrero EM, Baumgartner RE, Federer AE, Mithani SK, Ruch DS, Richard MJ. Complications of Low-Profile Plate Fixation of Phalanx Fractures. Hand (N Y) 2021; 16:248-252. [PMID: 31204487 PMCID: PMC8041415 DOI: 10.1177/1558944719855684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Phalanx fractures are common, and plate fixation can be used to treat difficult fractures. Major complications have been reported in up to 64% of phalanx fractures treated with plate fixation, with stiffness being the most common. Low-profile anatomic plates (LPAP) have been designed to decrease soft tissue irritation and postoperative stiffness. The objective of this study was to determine whether the use of LPAP has decreased complications in plate fixation of phalanx fractures. Methods: A retrospective chart review was performed of patients with phalanx fractures treated with open reduction and internal fixation (ORIF) using LPAP at a single institution from January 1, 2010, to January 25, 2018. Twenty-three patients with 23 phalanx fractures treated with LPAP were included. The primary outcome was the presence of a complication. Results: Of the 23 patients, 12 patients (52.2%) had a postoperative complication. Nine patients (39.1%) required return to the operating room, with 7 (30.4%) returning for removal of hardware and tenolysis/capsulotomy. Two patients (8.7%) had superficial infections, one requiring irrigation and debridement. The other infection resolved clinically after 2 courses of oral antibiotics, with the fracture going on to nonunion. One patient had delayed wound healing treated prophylactically with cephalexin; although the wound healed, the patient developed a boutonniere deformity requiring surgery. There were 2 malunions (8.7%), one requiring revision surgery and the other electing for nonoperative management. All but one fracture progressed to union. Conclusions: ORIF with LPAP consistently achieves fracture union for phalanx fractures, but it does not appear that LPAP reduce the high complication rate.
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Affiliation(s)
- Evan M. Guerrero
- Duke University Medical Center, Durham, NC, USA,Evan M. Guerrero, Department of Orthopaedic Surgery, Duke University Medical Center, DUMC Box 3000, Durham, NC 27710, USA.
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21
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Rausch V, Harbrecht A, Kahmann SL, Fenten T, Jovanovic N, Hackl M, Müller LP, Staat M, Wegmann K. Osteosynthesis of Phalangeal Fractures: Biomechanical Comparison of Kirschner Wires, Plates, and Compression Screws. J Hand Surg Am 2020; 45:987.e1-987.e8. [PMID: 32499069 DOI: 10.1016/j.jhsa.2020.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/14/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model. METHODS A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine. RESULTS Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup. CONCLUSIONS Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability. CLINICAL RELEVANCE Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.
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Affiliation(s)
- Valentin Rausch
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Andreas Harbrecht
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany; Department of Anatomy I, Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Stephanie L Kahmann
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany; Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Thomas Fenten
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Nebojsa Jovanovic
- Department of Trauma and Orthopedics, Hand and Microsurgery Unit, Rashid Hospital, Dubai Health Authority, Oud Metha, Dubai
| | - Michael Hackl
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Lars P Müller
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
| | - Manfred Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Kilian Wegmann
- Faculty of Medicine, University of Cologne, Center for Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany
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22
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Kootstra TJM, Keizer J, Bhashyam A, Houwert RM, Verleisdonk EJMM, van Heijl M, van der Velde D. Patient-Reported Outcomes and Complications After Surgical Fixation of 143 Proximal Phalanx Fractures. J Hand Surg Am 2020; 45:327-334. [PMID: 31585743 DOI: 10.1016/j.jhsa.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/11/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple methods exist to surgically fix unstable phalangeal fractures. Whereas these methods have different rates of complications or reoperation, it is not known whether these differences lead to changes in patient reported outcome. We compared patient-reported outcomes measures and complications of Kirschner wire (K-wire), lag-screw and plate fixation of proximal phalanx fractures (excluding the thumb). METHODS From 2010 to 2015, 159 patients with 159 proximal phalanx fractures were identified in 2 level 2 trauma centers and fixed with K-wires (44% of patients), lag-screws (26%), or plates (30%). Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) and complications were assessed. In addition, subjective outcomes were assessed. Follow-up was achieved for 143 fractures (90%) and average time to follow-up was 3.4 years. RESULTS Mean DASH and PRWHE scores were 5.0 and 8.2, respectively. No differences in functional outcomes were found between fixation methods, although unplanned reoperation was more common in the plate fixation group (9 patients; 21%) than in the K-wire and lag-screw fixation groups (3 patients and 1 patient; 4.8 and 2.7%, respectively). We also found that K-wire fixation was associated with better aesthetic outcome than open reduction internal fixation. CONCLUSIONS Overall patient-reported outcomes measure scores were similar across fixation methods, and unplanned reoperation was more prevalent after plate fixation. In addition, we found that regardless of fracture pattern, percutaneous fixation with K-wires was often sufficient and associated with better aesthetic outcome than open reduction and internal fixation. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Thomas J M Kootstra
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
| | - Jort Keizer
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Abhiram Bhashyam
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Roderick M Houwert
- Department of Surgery, Universitair Medisch Centrum, Utrecht, The Netherlands
| | | | - Mark van Heijl
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands; Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands
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23
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Ahmed Z, Haider MI, Buzdar MI, Bakht Chugtai B, Rashid M, Hussain N, Ali F. Comparison of Miniplate and K-wire in the Treatment of Metacarpal and Phalangeal Fractures. Cureus 2020; 12:e7039. [PMID: 32211271 PMCID: PMC7083253 DOI: 10.7759/cureus.7039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Metacarpal and phalangeal fractures are common upper limb fractures due to direct blows, axial loading, and torsional loading injuries. The universal goal in treating all fractures for the patient to achieve normal motion, but the ideal technique for stabilization is still debated. For internal fixation, Kirschner wires (K-wires) or miniplates can be used, and each carries certain advantages. No previous study has compared K-wire use to miniplate use in treating metacarpal and phalangeal fractures. Therefore, we conducted this randomized control trial to evaluate the outcomes of K-wire and miniplate use in treating metacarpal and phalangeal fractures. Materials and methods This randomized controlled trial was conducted in the Department of Orthopaedic Surgery, Bahawal Victoria Hospital, from February 2017 to February 2018. Seventy-five patients were included in this study and randomly assigned into two groups. One group was treated with K-wire fixation, and the other group was treated with miniplate fixation. We assessed total active motion (TAM), range of motion (ROM), duration of injury, and complication rate. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Armonk, NY: IBM Corp). P values ≤ 0.05 were considered significant. Results Mean surgical time, pain scale, and time of union of K-wire treated patients was 38.63±3.64 minutes, 4.17±1.11, and 12.95±3.38 weeks, respectively. The success of the union was noted in 38 K-wire patients (95%). Total active ROM was greater in miniplate fixation patients compared with K-wire treated patients, but this difference was statistically significant. Similarly, TAM was also greater in the miniplate fixation patients compared to the K-wire treated patients, but this difference was also not statistically significant. Conclusion Both K-wire fixation and miniplate fixation are equally effective in terms of TAM, ROM, and complications when used to treat metacarpal and phalangeal fractures.
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Affiliation(s)
- Zulfiqar Ahmed
- Orthopaedics, Bahawal Victoria Hospital, Bahawalpur, PAK
| | | | - M Iqbal Buzdar
- Orthopaedics, Bahawal Victoria Hospital, Bahawalpur, PAK
| | | | - Majid Rashid
- Orthopaedics, Sahiwal Medical College, Sahiwal, PAK
| | - Nazar Hussain
- Orthopaedics, Bahawal Victoria Hospital, Bahawalpur, PAK
| | - Farman Ali
- Anaesthesia, DHQ Khanewal, Khanewale, PAK
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O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One 2020; 15:e0227907. [PMID: 31940334 PMCID: PMC6961943 DOI: 10.1371/journal.pone.0227907] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8-109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8-30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient's socioeconomic well-being, which may negatively affect a person's psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.
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Affiliation(s)
- Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marckenley Isaac
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Maharaj R, Khatua J, Nanda D, Panigrahi R. Comparison of conservative and operative management for unstable extra articular proximal phalanx fracture of hand: A prospective study. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Köse A, Engin MÇ, Topal M, Köse M, Şencan A. Ekstraartiküler Proksimal Falanks Kırıklarında Kapalı Redüksiyon ve Kirschner Teli Tespitin Klinik ve Radyolojik Sonuçları. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.468120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Quadlbauer S, Pezzei C, Hintringer W, Hausner T, Leixnering M. [Percutaneous treatment of unstable fractures of the base of the middle phalanx : Technique according to Hintringer and Ender]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:384-392. [PMID: 31346631 DOI: 10.1007/s00064-019-0621-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Reconstruction of intra-articular impression fractures of the middle phalanx by percutaneous reduction over a small dorsal cortical window. Stabilization by lattice-like arranged K‑wires. INDICATIONS Impression fractures of the base of the middle phalanx with or without dislocation in the proximal interphalangeal joint. CONTRAINDICATIONS Fractures extending to the shaft of the middle phalanx. SURGICAL TECHNIQUE By a cortical window at the dorsum of the middle phalanx (through the tendon free triangle) the impression fracture is reduced from the medullary cavity. Reduction is secured and the articular surface is supported by lattice-like arranged K‑wires. POSTOPERATIVE MANAGEMENT Thermoplastic splint for the finger for 6 weeks, subsequently K‑wire removal, active range of motion exercises and hand occupational therapy. RESULTS In two case series already published, good clinical and radiological results were reported. No complications were detected in either series.
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Affiliation(s)
- S Quadlbauer
- AUVA Unfallkrankenhaus Lorenz Böhler - European Hand Trauma Center, 1200, Wien, Österreich. .,Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie, AUVA Research Center, 1200, Wien, Österreich. .,Austrian Cluster for Tissue Regeneration, 1200, Wien, Österreich.
| | - C Pezzei
- AUVA Unfallkrankenhaus Lorenz Böhler - European Hand Trauma Center, 1200, Wien, Österreich
| | - W Hintringer
- Ordination für Handchirurgie, 2100, Korneuburg, Österreich
| | - T Hausner
- AUVA Unfallkrankenhaus Lorenz Böhler - European Hand Trauma Center, 1200, Wien, Österreich.,Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie, AUVA Research Center, 1200, Wien, Österreich.,Austrian Cluster for Tissue Regeneration, 1200, Wien, Österreich.,Abteilung Orthopädie und Traumatologie, Paracelsius Medizinische Universität, 5020, Salzburg, Österreich
| | - M Leixnering
- AUVA Unfallkrankenhaus Lorenz Böhler - European Hand Trauma Center, 1200, Wien, Österreich
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Gaspar MP, Gandhi SD, Culp RW, Kane PM. Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures. Hand (N Y) 2019; 14:494-499. [PMID: 29319352 PMCID: PMC6760084 DOI: 10.1177/1558944717750919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers' compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.
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Affiliation(s)
- Michael P. Gaspar
- Thomas Jefferson University, Philadelphia, PA, USA,University of Virginia, Charlottesville, USA,Michael P. Gaspar, Philadelphia Hand to Shoulder Center, Department of Orthopedic Surgery, Thomas Jefferson University, The Franklin Building, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107, USA.
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[Open reduction and plate/screw osteosynthesis of proximal phalanx fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:408-421. [PMID: 30980086 DOI: 10.1007/s00064-019-0598-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/17/2018] [Accepted: 03/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Anatomical open reduction and internal fixation using screw/plate osteosynthesis. INDICATIONS Extra-articular fractures with clinically evident malrotation of the finger, comminution fracture and/or loss of length, which cannot be treated non-operatively; fracture instability; intra-articular fracture with step off greater than 1 mm, which cannot be treated percutaneously but openly using plate/screw osteosythesis; failure of conservative treatment. CONTRAINDICATIONS General operative limitations. SURGICAL TECHNIQUE Dorsal, mediolateral, or palmar approach, temporary reduction using pincers or optional Kirschner wires; screw/plate osteosynthesis for internal fixation. POSTOPERATIVE MANAGEMENT Immediate mobilization facilitated by buddy loops for the first 4-6 weeks, prevention of edema using elastic dressing, physiotherapy. RESULTS Open reduction and internal fixation using screw/plate osteosynthesis provides good results in combination with immediate mobilization. Nevertheless, adhesion of tendons or capsule tissue with restriction of range of motion is observed.
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Köse A, Topal M, Engin MÇ, Şencan A, Dinçer R, Baran T. Comparison of low-profile plate-screw and Kirschner-wire osteosynthesis outcomes in extra-articular unstable proximal phalangeal fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:597-604. [PMID: 30426217 DOI: 10.1007/s00590-018-2342-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to present the radiological and clinical results of Kirschner-wire (K-wire) fixation and low-profile plate-screw fixation applied to unstable proximal phalangeal fractures without extension to the joint. METHODS Clinical and radiological data of 22 patients who underwent fixation with open reduction and low-profile 1.5-mm titanium mini plate and unlocked screws and 18 patients who underwent fixation with K-wire due to closed, unstable extra-articular proximal phalangeal fractures were retrospectively examined. All evaluation and statistical analyses were based on sixth postoperative month evaluation parameters. Active and passive metacarpophalangeal joint and interphalangeal joint range of motions, total joint range of motion, measurement of grip strength for fractured and healthy hands, visual analog scoring, disabilities of the arm, shoulder, and hand scores, measurement of distance between the pulpa and palmar curve in the operated finger, Belsky score, reoperation, and complications were evaluated. RESULTS Radiological union was achieved in all patients in a mean duration of 4.2 (3-6) weeks. When the functional results of the patients were evaluated, the mean active metacarpophalangeal joint flexion was 87.3° (75°-90°), mean proximal interphalangeal joint flexion was 94.3° (65°-100°), mean distal interphalangeal joint flexion was 77.6° (75°-80°), and mean total range of motion was 259° (210°-270°). The grip strength of the fractured hand was 52.7 (40-58) kgW, whereas that of the healthy hand was 54.4 (42-60) kgW. The mean value of visual analog score was 0.8 (0-2), mean score for disabilities of the arm, shoulder, and hand was 7 (2-27), and mean distance between the finger pulpa and finger curve was 3 (0-8) mm. CONCLUSION Plate-screw osteosynthesis in the extra-articular, unstable fractures of the proximal phalanx, which is "small" compared with the body but has a "major function" for the hand and upper extremity, allows for rigid fixation, short immobilization, and early motion in spiral/oblique-fragmented fractures. K-wire fixation, an alternative treatment modality, applied to selected fracture patterns with appropriate indications can achieve good-excellent results radiologically and functionally.
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Affiliation(s)
- Ahmet Köse
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Murat Topal
- Department of Orthopedics and Traumatology, Kastamonu University, Kastamonu, Turkey
| | | | - Ayşe Şencan
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Health Sciences University, İstanbul, Turkey
| | - Recep Dinçer
- Department of Orthopedics and Traumatology, Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Tuncay Baran
- Department of Orthopedics and Traumatology, Gölcük State Hospital, Kocaeli, Turkey
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Abstract
BACKGROUND The goal of proximal phalangeal fracture management is to allow for fracture healing to occur in acceptable alignment while maintaining gliding motion of the extensor and flexor tendons. METHODS We reviewed the most current literature on various treatment methods of proximal phalanx fractures, focusing on the indications and outcomes of nonoperative as well as operative interventions. RESULTS Stable fractures can be successfully treated nonoperatively, whereas unstable injuries benefit from surgery. Regardless of the surgical intervention employed, the overriding goal is to restore anatomy and impart enough stability to allow for early motion. The surgical dissection contributes to soft tissue scarring and should be minimized. CONCLUSIONS Clinical success is achieved when acceptable fracture alignment and stability occur in the setting of unobstructed tendon gliding and early active range of motion.
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Affiliation(s)
| | | | | | | | - Robert A. Kaufmann
- University of Pittsburgh Medical Center, PA, USA,Robert A. Kaufmann, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Suite 1010 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Chen HW, He HH, Gao BL. Efficacy of internal fixation with mini plate and internal fixation with hollow screw for Regan-Morrey type II and III ulna coronoid fractures. BMC Musculoskelet Disord 2018; 19:194. [PMID: 29921248 PMCID: PMC6011204 DOI: 10.1186/s12891-018-2117-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ulna coronoid fracture is a complicated injury and occurred in the coronal plane. Undeniably, there is no universally accepted approach for treating ulna coronoid fractures. Therefore, this study aimed at exploring the efficacy of different surgical treatments for Regan-Morrey type II and III ulna coronoid fractures. METHODS A total of 164 patients with ulna coronoid fractures were admitted and treated in department of orthopedics at Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University for retrospective analysis. The baseline features (age, gender, time from injury to surgery and so on) before the surgery and different conditions during the surgery were compared. Following that, the Visual Analogue Scale (VAS) pain score was employed to evaluate the severity of preoperative and postoperative pain experienced by the patients in each group. Afterwards, Broberg and Morrey elbow score was used to evaluate elbow joint function and surgical effect of the patients. Lastly, the postoperative recovery and complications were compared. RESULTS It was firstly observed that internal fixation with mini plate and hollow screw compelled to lower average operation time and blood loss than Kirschner wire and steel wire suture. Next, the severity of postoperative pain was lessened in comparison with preoperative pain. Afterwards, mini plate and hollow screw improved elbow joint function more notable than Kirschner wire and steel wire suture, and Kirschner wire and steel wire suture resulted in higher incidence of complications and worse postoperative recovery. CONCLUSION Collectively, this study clarified that for the treatment of Regan-Morrey type II and III ulna coronoid fractures, internal fixation with mini plate and hollow screw has an overall superior surgical effect than internal fixation with Kirschner wire and steel wire suture.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedic Surgery, Yiwu Central Hospital, the Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, 322000, People's Republic of China
| | - Hong-Hui He
- Department of Joint Surgery and Sports Medicine, the Affiliated Nanhua Hospital, University of South China, Hengyang, 421002, People's Republic of China
| | - Bin-Li Gao
- Department of Orthopedics, the Affiliated Hospital of Inner Mongolia Medical University, No. 1, Tongdao North Road, Hohhot, 010050, The Inner Mongolia Autonomous Region, People's Republic of China.
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Eu-Jin Cheah A, Behn AW, Comer G, Yao J. A Biomechanical Analysis of 2 Constructs for Metacarpal Spiral Fracture Fixation in a Cadaver Model: 2 Large Screws Versus 3 Small Screws. J Hand Surg Am 2017; 42:1033.e1-1033.e6. [PMID: 28888569 DOI: 10.1016/j.jhsa.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/27/2017] [Accepted: 07/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgeons confronted with a long spiral metacarpal fracture may choose to fix it solely with lagged screws. A biomechanical analysis of a metacarpal spiral fracture model was performed to determine whether 3 1.5-mm screws or 2 2.0-mm screws provided more stability during bending and torsional loading. METHODS Second and third metacarpals were harvested from 12 matched pairs of fresh-frozen cadaveric hands and spiral fractures were created. One specimen from each matched pair was fixed with 2 2.0-mm lagged screws whereas the other was fixed with 3 1.5-mm lagged screws. Nine pairs underwent combined cyclic cantilever bending and axial compressive loading followed by loading to failure. Nine additional pairs were subjected to cyclic external rotation while under a constant axial compressive load and were subsequently externally rotated to failure under a constant axial compressive load. Paired t tests were used to compare cyclic creep, stiffness, displacement, rotation, and peak load levels. RESULTS Average failure torque for all specimens was 7.2 ± 1.7 Nm. In cyclic torsional testing, the group with 2 screws exhibited significantly less rotational creep than the one with 3 screws. A single specimen in the group with 2 screws failed before cyclic bending tests were completed. No other significant differences were found between test groups during torsional or bending tests. CONCLUSIONS Both constructs were biomechanically similar except that the construct with 2 screws displayed significantly less loosening during torsional cyclic loading, although the difference was small and may not be clinically meaningful. CLINICAL RELEVANCE Because we found no obvious biomechanical advantage to using 3 1.5-mm lagged screws to fix long spiral metacarpal fractures, the time efficiency and decreased implant costs of using 2-2.0 mm lagged screws may be preferred.
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Affiliation(s)
- Andre Eu-Jin Cheah
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA; Department of Hand and Reconstructive Microsurgery, National University Hospital, National University Health System, Singapore
| | - Anthony W Behn
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Garet Comer
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA.
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Abstract
LEARNING OBJECTIVES 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. BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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von Kieseritzky J, Nordström J, Arner M. Reoperations and postoperative complications after osteosynthesis of phalangeal fractures: a retrospective cohort study. J Plast Surg Hand Surg 2017; 51:458-462. [DOI: 10.1080/2000656x.2017.1313261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna von Kieseritzky
- Department of Clinical Science and Education; and the Department of Hand Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Nordström
- Department of Clinical Science and Education; and the Department of Hand Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Arner
- Department of Clinical Science and Education; and the Department of Hand Surgery, Karolinska Institutet, Stockholm, Sweden
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Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures. HAND SURGERY & REHABILITATION 2017; 36:127-135. [DOI: 10.1016/j.hansur.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/10/2016] [Accepted: 08/08/2016] [Indexed: 11/23/2022]
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Robinson LP, Gaspar MP, Strohl AB, Teplitsky SL, Gandhi SD, Kane PM, Osterman AL. Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study. Arch Orthop Trauma Surg 2017; 137:567-572. [PMID: 28236187 DOI: 10.1007/s00402-017-2650-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Unstable proximal phalanx fractures are relatively common injuries but consensus of standard treatment is lacking. Outcomes following plate fixation are highly variable, and it remains unclear which factors are predictive for poorer results. The purpose of this study was to compare dorsal and lateral plate fixation of finger proximal phalangeal fractures with regard to factors that influence the outcome. MATERIALS AND METHODS A retrospective chart review of proximal phalanx fractures treated with dorsal and lateral plating over a 6-year study interval was performed. Demographic data and injury-specific factors were obtained from review of clinic and therapy notes of 42 patients. Fractures were classified based on the OTA classification using preoperative radiographs. Outcomes investigated included final range of motion (ROM) and total active motion (TAM) of all finger joints. Complications and revision surgeries were also analyzed. RESULTS Fracture comminution, dorsal and a lateral plate position, occupational therapy, and demographic factors did not significantly influence the outcome, complication, and revision rate after plate fixation of finger proximal phalangeal fractures. CONCLUSIONS Based on the results of this study, no differences in the outcome of finger proximal phalangeal fractures treated by both dorsal and lateral plate fixation were observed. LEVEL OF EVIDENCE Therapeutic, retrospective comparative, level III.
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Affiliation(s)
- Luke P Robinson
- Louisville Arm and Hand, Louisville, KY, 40202, USA.,Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Michael P Gaspar
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Adam B Strohl
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Seth L Teplitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Shiv D Gandhi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Patrick M Kane
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - A Lee Osterman
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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Treatment of extra-articular proximal and middle phalangeal fractures of the hand: a systematic review. Strategies Trauma Limb Reconstr 2017; 12:63-76. [PMID: 28260179 PMCID: PMC5505877 DOI: 10.1007/s11751-017-0279-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/24/2017] [Indexed: 01/09/2023] Open
Abstract
The aim of the study was to systematically review the patient reported and functional outcomes of treatment for extra-articular proximal or middle phalangeal fractures of the hand in order to determine the best treatment options. The review methodology was registered with PROSPERO. A systematic literature search was conducted in electronic bibliographic databases. Two independent reviewers performed screening and data extraction. The evaluation of quality of the included studies was performed using the Structured Effectiveness Quality Evaluation scale. The initial search yielded 2354 studies. The full text manuscripts of 79 studies were evaluated of which 16 studies met the inclusion criteria. In total, 513 extra-articular proximal and middle phalangeal fractures of the hand were included of which 118 (23%) were treated non-operatively, 188 (37%) were treated by closed reduction internal fixation (CRIF) and 207 (40%) by open reduction internal fixation. It can be recommended that closed displaced extra-articular phalangeal fractures can be treated non-operatively, even fractures with an oblique or complex pattern, provided that closed reduction is possible and maintained. Conservative treatment is preferably performed with a cast/brace allowing free mobilization of the wrist. No definite conclusion could be drawn upon whether closed reduction with extra-articular K-wire pinning or transarticular pinning is superior; however, it might be suggested that extra-articular K-wire pinning is favoured. When open reduction is necessary for oblique or spiral extra-articular fractures, lag screw fixation is preferable to plate and screw fixation. But, similar recovery and functional results are achieved with transversally inserted K-wires compared to lag screw fixation. Type of study/level of evidence: therapeutic III.
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Lee JK, Jo YG, Kim JW, Choi YS, Han SH. Open reduction and internal fixation for intraarticular fracture of metacarpal head. DER ORTHOPADE 2017; 46:617-624. [DOI: 10.1007/s00132-017-3392-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Hand fracture fixation in mutilating injuries is characterized by multiple challenges due to possible skeletal disorganization and concomitant severe injury of soft tissue structures. The effects of skeletal disruption are best analyzed as divided into specific locales in the hand: radial, ulnar, proximal, and distal. Functional consequences of injuries in each of these regions are discussed. Although a variety of implants are now in vogue, K-wire fixation has stood the test of time and is especially useful in multiple fracture situations. Segmental bone loss is quite common in such injuries, which can be safely reconstructed in a staged manner.
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Affiliation(s)
- Praveen Bhardwaj
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
| | - Ajeesh Sankaran
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
| | - S Raja Sabapathy
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
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Unglaub F, Langer MF, Hahn P, Müller LP, Ahrens C, Spies CK. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options]. Unfallchirurg 2016; 119:133-43; quiz 144-5. [PMID: 26826026 DOI: 10.1007/s00113-016-0142-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.
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Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Hahn
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - L P Müller
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - C Ahrens
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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Nuland K, Charette R, Rodner CM. Operative Treatment of Unstable Long Oblique Proximal Phalanx Fractures. J Hand Surg Am 2016; 41:120-1. [PMID: 26433245 DOI: 10.1016/j.jhsa.2015.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/29/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Kyle Nuland
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Ryan Charette
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Craig M Rodner
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT.
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