Minimally Invasive Procedure for Correcting Extra-Articular Malunions of Metacarpals and Phalanges

A minimally invasive technique for correcting extra-articular malunions of metacarpal fractures

PURPOSE

This study aimed to assess the efficiency of a minimally invasive technique for correcting malunions of extra-articular metacarpal fractures, followed by percutaneous fixation using a cemented K-wire frame.

METHODS

From January 2018 to January 2022, 31 patients (31 malunions of extra-articular metacarpal fractures) were treated. The mean age of the patients was 32 years (range, 21-52 years). There were 25 fifth, 4 fourth, 1 third, and 1 second metacarpal malunion. Range of motion of the fingers was assessed based on the total active motion scoring system of American Society for Surgery of the Hand. Range of motion of the joint was graded as excellent (85-100%), good (70-84%), fair (50-69%), and poor (< 50%) by comparing to the opposite uninjured finger. The aesthetic appearance of the hand was evaluated based on the 10-cm visual analogue scale. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (0-10, very dissatisfied; 11-18, dissatisfied; 19-26, satisfied; and 27-28, very satisfied).

RESULTS

Bone healing was achieved in all patients after a mean of 5.4 weeks (range, 4-10 weeks). The mean follow-up period was 27 months (range, 24-33 months). The mean preoperative total active motion scale was 233° (range, 185°-288°), and the postoperative scale was 263° (range, 235°-290°). There were 8 excellent, 19 good, and 1 fair result. There were 15 very satisfied and 13 satisfied with the results. The mean preoperative aesthetic appearance of the hand was 7 cm (range, 5-8 cm), and the postoperative appearance was 10 cm (range, 9-10 cm).

CONCLUSION

The minimally invasive technique is effective for correcting extra-articular malunions of metacarpal fractures. Rigid fixation allows fracture healing and early joint motion of the injured hand. The technique improves hand function, patient satisfaction, and aesthetic appearance.

LEVEL OF EVIDENCE

Therapeutic study, Level IVa.

Retrograde intramedullary headless compression screw fixation for pediatric mid-diaphyseal proximal phalanx malunion: A case study

INTRODUCTION

Proximal phalanx fractures in children, especially mid-diaphyseal fractures, can result in malunion and significant functional impairment. Early malunions require prompt and effective intervention to prevent long-term complications. This case study highlights the use of intramedullary headless compression screw (IMHCS) fixation in addressing a proximal phalanx malunion.

CASE PRESENTATION

A 12-year-old boy presented with a malunion of the mid-diaphyseal proximal phalanx of the fourth finger following conservative treatment of a cycling injury. Initial management involved immobilization followed by buddy taping; however, incomplete radiographic evaluation resulted in an underestimation of the volar angulation. At the four-week follow-up, the patient exhibited 50° volar angulation, clinodactyly, and marked stiffness. The malunion was treated surgically with retrograde IMHCS fixation after osteoclasis. Radiographic evaluation confirmed proper reduction and alignment. The patient began physical therapy immediately, achieved full range of motion within four weeks and maintained excellent functional outcomes at one year postoperatively.

DISCUSSION

Retrograde IMHCS fixation is an innovative technique for managing phalangeal malunions, providing stable fixation and enabling early mobilization. This method avoids the physis, minimizing the risk of growth disturbances, eliminates the need for hardware removal, and ensures proper alignment.

CONCLUSION

IMHCS fixation is a promising solution for early malunions and potentially fresh fractures of the proximal phalanx in pediatric patients. It offers stable fixation, preserves physeal integrity, and supports early rehabilitation, contributing to excellent functional recovery. Further studies are needed to evaluate its long-term outcomes.

Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review

PURPOSE

There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures.

METHODS

A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data.

RESULTS

Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery.

CONCLUSIONS

Complications following IMS fixation of metacarpal fractures are relatively uncommon.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Minimally invasive corrective derotational osteotomy for proximal phalanx malrotation

Fractures of the phalanges may result in a challenging complication known as malrotation, which can adversely affect the functionality of the fingers during flexion, leading to scissoring. The standard surgical approach for correcting this condition involves open corrective osteotomy and derotation, often at the level of the metacarpal, which includes the use of different techniques for osteotomy and fixation. However, postoperative complications such as finger stiffness and hardware irritation are common. To overcome these limitations, we present a novel and minimally invasive corrective osteotomy technique for malunited proximal phalanx fractures with rotational malalignment, which offers several advantages, such as accelerated rehabilitation and no prominent hardware.