A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures

Screw Position Following Percutaneous Versus Mini-Open Intramedullary Retrograde Screw Fixation of Metacarpal Fractures

BACKGROUND

Metacarpal fracture fixation using the retrograde intramedullary screw technique can be performed through two different approaches. The mini-open approach requires greater soft tissue dissection but allows for direct visualization of the metacarpal head compared with the percutaneous approach. Our aim was to determine which approach resulted in optimal screw position.

METHODS

Eighty-one consecutive patients that underwent intramedullary screw fixation for metacarpal fractures from 2016 to 2021 were identified. Patients were treated by 4 fellowship-trained orthopedic hand surgeons who employed the mini-open or percutaneous approach. Postoperative radiographs were reviewed for screw position.

RESULTS

A total of 81 patients (41 mini-open, 40 percutaneous) were included in this study. There were no significant differences between the two groups in age, sex, hand dominance, or affected digit. Postoperative screw position at first postoperative visit was not significantly different between the two groups on anteroposterior or lateral radiographs.

CONCLUSION

Postoperative screw position is not significantly different between the mini-open and percutaneous approaches for intramedullary screw fixation of metacarpal fractures.

LEVEL OF EVIDENCE

Level III, therapeutic.

Research and Development of a 3D-Printed Dynamic Finger Flexion Orthosis for Finger Extension Stiffness-A Preliminary Study

Finger extension stiffness is a common post-traumatic complication that results in the hand's functional impairment. In clinical practice, a dynamic splint enables the patient to stretch the affected finger independently. However, current dynamic splints have drawbacks, such as limited stretching efficacy, and interfere with the hand's functional activities. Therefore, this study aimed to develop a dynamic finger flexion orthosis capable of stretching each finger joint using additive manufacturing (AM) technology, thereby enabling hand functional activity, and analyze the clinical improvement in the range of motion (ROM). One subject with a hand fracture was recruited while undergoing a 7-week home-based rehabilitation program for the orthosis. The outcome measurements included the total active motion (TAM), the tip-to-finger distance (TPD), and the score on the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The results show that the TAM of the participant's fingers increased by 72.7 degrees on average, the TPD decreased by 3.5 cm on average, and the DASH score decreased to 9.5 points. The 7-week home-based rehabilitation program for the orthosis resulted in a 53.6% increase in the TAM on average. The developed orthosis improved hand function and enabled a more complete ROM in finger flexion.

Metacarpal Shortening with Intramedullary Screw Fixation: A Cadaveric Study

Background  Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes  Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods  The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy. Three different intramedullary screw designs were compared. Each screw was placed in a retrograde fashion into the intramedullary canal and the amount of shortening measured. Screws were reversed and the number of reverse turns with the screwdriver needed to release overshortening were measured. Results  The average shortening at the osteotomy site was 2.5 mm. The mean shortening was 80%, 58%, and 12% for the partially threaded screw, fully threaded screw, and threaded nail, respectively. The mean differences of the distance shortened were statistically significant for the threaded nail compared with the partially and fully threaded screws. The partially threaded screw had the most shortening, while the threaded nail provided the least amount of shortening. When the screws were reversed, the screws did not disengage until the screw was fully removed from the osteotomy site. Conclusion  The fully threaded nail demonstrates less shortening and possibly minimizes overshortening of fractures compared with partially threaded and fully threaded screw designs. Overshortening cannot be corrected by unscrewing the screw unless completely removed from the distal fragment. Clinical Relevance  Orthopaedic surgeons may select intermedullary screws based on the design that is suited for the particular metacarpal fracture pattern.

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

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

Arthrodesis for Carpometacarpal Joint Arthritis: A Systematic Review

BACKGROUND

This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first carpometacarpal joint.

METHODS

A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Google Scholar. Articles located by the search were independently assessed by title, abstract, or full article review for inclusion or exclusion. Demographic, outcome, and complication data from included articles were extracted, compiled, and analyzed. Frequency-weighted means and proportions were generated.

RESULTS

In total, 21 articles met inclusion and exclusion criteria accounting for 802 patients and 914 thumbs. Average age at time of surgery was 55.4 years, and mean follow-up time was 72.7 months. Arthrodesis techniques include Kirschner-wire fixation (51.3%), plate fixation (24.6%), screw fixation (9.8%), tension band technique (7.1%), staple fixation (7.0%), and none (<0.1%). Mean preoperative Disabilities of the Arm, Shoulder and Hand score was 58 and 25.4 postoperatively (∆ = -32.6 points). Mean preoperative visual analogue scale score was 6.8 and 1.9 postoperatively (∆ = -4.9 points). Mean preoperative grip strength was 15.7 kg, and 23.0 kg postoperatively (∆ = +7.3 kg). In all, 48.7% of thumbs had complications, 15.1% of which were major, while 33.6% were minor. The most common major complication was symptomatic hardware (8.6%) requiring return to the operating room, and the most common minor complications were peritrapezial arthritis (8.5%) and nonunion (8.4%).

CONCLUSIONS

Arthrodesis for arthritis of the trapeziometacarpal joint is associated with good functional outcomes and low to moderate patient-reported disability and pain scores, but a high complication rate.

LEVEL OF EVIDENCE

IV.

METACARPAL FRACTURES TREATMENT: COMPARASION BETWEEN KIRSCHNER WIRE AND INTRAMEDULLARY SCREW

Introduction

Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS).

Objectives

Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS.

Results

The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group.

Conclusion

The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

Biomechanical study of the fixation ability of the dorsal and volar locking plate for transverse metacarpal neck fractures

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.

Comparative study on the effectiveness of bone grafting for arthrodesis of the thumb carpometacarpal arthritis

The aim of this retrospective study was to assess the effectiveness of autogenous bone grafting for arthrodesis of the thumb carpometacarpal joint by comparing the bone union rates with and without bone grafting. We included 36 patients who underwent arthrodesis of the thumb carpometacarpal joint for arthritis (20 patients with bone grafts and 16 without bone grafts). Implants used for internal fixation were K-wire, tension band wiring, headless compression screw and locking plate. The presence of bone union and the time from surgery to bone union were evaluated. The bone union rate was 20/20 (100%) in the bone grafting group and 12/16 (75%) in the non-bone grafting group (p = 0.03). There were no significant differences between the two groups in the time from surgery to bone union and patient characteristics. In conclusion, autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis.Level of evidence: III.

A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures

The aim of this study is to compare clinical and radiographic outcomes of open reduction and internal fixation versus closed reduction and percutaneous pinning of metacarpal fractures in relation to anatomic and surgical variables.

Methods

Electronic medical records at two institutions were reviewed for patients who underwent surgical intervention for metacarpal fractures. Data were collected from those who underwent reduction and internal fixation with either plates or Kirschner wires (K-wires). Inclusion criteria included minimum postoperative follow-up of 60 days and age 18 years or older. Exclusion criteria included insufficient radiographic data, previously attempted closed reduction with immobilization, pathologic fracture mechanism, history of previous trauma or surgery to the affected bone, and fixation technique other than plate or K-wire.

Results

We reviewed data for patients treated over a 22-year time period. Ultimately, 81 metacarpal shaft and neck fractures in 60 patients met inclusion criteria. Among all metacarpal fractures, complications were present in 39 (48.1%) cases. There were no significant associations between complication prevalence and hardware type. Revision surgery was required in 11 (13.6%) patients; there were no significant associations between revision procedures and hardware type. Postoperatively, all patients with imaging data had radiograph follow-up to assess union status. There was no significant association between time to union and hardware type.

Conclusions

Outcomes showed no significant difference between plate and pin fixation for metacarpal shaft and neck fractures. These findings suggest that surgeons may have flexibility to decide on the type of operative intervention while considering patient-specific factors, such as the need for early mobilization.

Biomechanical analysis of locking plates for fixation of metacarpal shaft fractures: A finite element analysis

BACKGROUND

There appears to be a paucity of knowledge about the biomechanics of locking plates for the fixation of metacarpal shaft fractures. A thorough understanding of the biomechanics of locking plates is needed to apply them correctly, optimize outcomes, and avoid complications. The purpose of this study is to investigate the biomechanics of the fixation of metacarpal fractures using locking plate-screw constructs with different numbers of screws.

HYPOTHESIS

The difference in the number of screws in the locking plate influenced the biomechanical outcome of the metacarpal fracture.

METHODS

Finite element models of third metacarpal fractures with locking plate-screw constructs were established, and the magnitude and distribution of their stresses and displacements were investigated when a vertical load of 100N was applied.

RESULTS

For the metacarpal fracture with a locking plate and screws, the stress in the metacarpal was largely shared by the plate-screw construct. For the plate-screw construct, the stress is concentrated in the area close to the fracture line, and the 6-screw Group has the lowest failure risk since it has the lowest plate stress and the second-lowest screw stress. The implant-bone construct with 8 screws has better biomechanical stability because of minimal displacement, but increased stress on both the metacarpal bone and the screws, leading to increased failure rates.

DISCUSSION

The stresses in the metacarpal were mostly shared by the plate-screw constructs and the screws closest to the fracture line were the most likely to break or loosen. For the implant-bone constructs, the locking plate with 2 screws was the most vulnerable to break or loosen, whereas the locking plate with 6 screws was the least likely to break or loosen. The implant-bone construct with 8 screws had better biomechanical stability, but the stresses in both the metacarpal and the screws were increased, which increased the risk of failure.

LEVEL OF EVIDENCE

IV, basic science study.

Blocking Screw Technique for Maintaining Reduction during Intramedullary Screw Fixation of Oblique Metacarpal Fractures

Intramedullary screw fixation provides a less-invasive means of surgically managing metacarpal fractures. While there are advantages to using this technique compared to CRPP and ORIF, disadvantages of intramedullary screw fixation include loss of reduction intraoperatively due to sagittal and coronal plane translation. The blocking screw technique has been previously described as a solution for this problem in intramedullary fixation of long bone fractures. We describe the blocking screw technique as applied to aid intramedullary screw fixation of metacarpals.

A Systematic Review of Treatment Interventions for Metacarpal Shaft Fractures in Adults

Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. A comprehensive search was conducted across multiple databases, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1600 records were identified; 7 studies fulfilled eligibility criteria and were included. No randomized controlled trials directly comparing surgery with nonsurgical treatment were found. One retrospective study compared nonsurgical with surgical treatment, whereas 6 compared surgical or nonsurgical treatments. Considerable heterogeneity between studies along with a high or critical risk of bias restricts direct comparison and conclusions. There is a lack of high-quality evidence to guide treatment, supporting the need for well-designed, multicenter trials to identify the most effective and cost-efficient treatment for metacarpal shaft fractures in adults.

Biomechanical study on fixation methods for horizontal oblique metacarpal shaft fractures

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.

The Conservative Treatment of Some Hand and Carpal Fractures

In recent decades, there has been a trend toward increased use of operative treatment of hand fractures. However, internal stabilization with wires or open reduction and internal fixation of the phalanges and the metacarpals carries a risk of surgical complications that can be avoided by using appropriate conservative treatment. In this article, some hand fractures that can be managed safely without surgery are discussed. In conclusion, when facing a fracture in the hand, the first consideration is whether the fracture can be treated nonoperatively and not which operative treatment is most appropriate. This applies to both displaced and undisplaced fractures.

Treatment of hand and finger fractures with the Stryker Hand Plating System

Objectives: 10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System. Patients and methods: Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters. Results: Three-quarters of the patients were male. The mean age at the time of surgery was 39.3±16 years. Falling was the leading cause for hand fractures, and the most common were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. Conclusion: The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. Level of Evidence: Level: IV; outcome-study, retrospective.

Comparison of the fixation ability between lag screw and bone plate for oblique metacarpal shaft fracture

Background

For oblique metacarpal shaft fracture, if anatomical reduction is achieved through conservative cast immobilization rather than stable fixation, bone malrotation can easily occur, resulting in severe loss in hand prehensile function. However, whether bone plate fixation or only lag screw fixation is more preferable remains unclear. Few studies have evaluated whether screw fixation can provide biomechanical fixation strength similar to bone plate fixation.

Objective

We assessed the difference in fixation strength between fixtation with two lag screws and bone plate for oblique metacarpal shaft fractures.

Materials and methods

We created oblique metacarpal shaft fractures on 21 artificial bones and fixated them using (1) double lag screw (2LS group), (2) regular plate (RP group), or (3) locked plate (LP group). To obtain the force–displacement data, a cantilever bending test was conducted for each specimen through a material testing machine. One-way analysis of variance and a Tukey test were conducted to compare the maximum fracture force and stiffness of the three fixation methods.

Results

The maximum fracture force of the 2LS group (mean + SD: 153.6 ± 26.5 N) was significantly lower than that of the RP (211.6 ± 18.5 N) and LP (227.5 ± 10.0 N) groups (p < 0.001). However, no significant differences were discovered between the RP and LP groups. The coefficient of variation for the maximum fracture force of the 2LS group (17.3%) was more than twice as high as that of the RP (8.7%) and LP (4.4%) groups. In addition, the stiffness of the three fixation methods was similar.

Conclusion

Compared with bone plate fixation, double lag screw fixation yielded slightly lower maximum bearable fracture force but similar stiffness. Therefore, this technique could be used for treating oblique metacarpal shaft fractures. However, using double lag screw fixation alone is technically demanding and requires considerable surgical experiences to produce consistent results.

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

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 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.

Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length

PURPOSE

The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2 years postoperatively.

METHODS

Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up.

RESULTS

The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38 mm. Union was achieved at mean 12.3 weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05 mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis.

CONCLUSIONS

AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation.

LEVEL OF EVIDENCE

Level IV, Retrospective case series.

Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument

Adequate positioning of the hand is a critical step in hand fracture operative repair that can impact both the clinical outcome and the efficiency of the operation. In this paper, we introduce the use of a thermoplastic splint with an added thumb stabilizing component as a means to increase the surgeon’s autonomy and to streamline the patient care pathway. The thermoplastic splint is custom fabricated preoperatively by the specialist hand therapist. The splint is used prior, during, and post operation with minimal modification. The thumb component assists maintaining the forearm in a stable pronated position whilst drilling and affixing metal work. This is demonstrated in the video of removal of metal work and open reduction and internal fixation of a metacarpal fracture.

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Background

Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side.

Objective

The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture.

Materials and methods

Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test.

Results

The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm).

Conclusion

According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures

OBJECTIVES

In this study, we aimed to compare clinical and radiographic outcomes of retrograde intramedullary Kirschner-wire (K-wire) fixation with those of plate-screw (PS) fixation.

PATIENTS AND METHODS

A total of 98 metacarpal shaft fractures in 75 patients (65 males, 10 females; mean age: 31.2±10.9 years; range, 16 to 65 years) were included between January 2011 and December 2017. The total joint active range of motion (AROM) and grip strength of the healthy and broken hands were evaluated. The Visual Analog Scale (VAS) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were recorded. We compared surgery duration, number of fluoroscopy images, and cost-effectiveness for each technique.

RESULTS

The overall mean follow-up was 21.9 (range, 12 to 56) months. At the last follow-up, total joint AROM (p=0.072), VAS score (p=0.298), QuickDASH score (p=0.132), and hand grip strength (p=0.947) were similar between the groups. Radiological union occurred in the PS and K-wire groups in a mean of 5.84 (range, 3 to 8) and 4.46 (range, 3 to 20) weeks, respectively (p=0.173). A significant difference was found in surgery duration (p=0.021) and number of fluoroscopy images (p<0.05) between the PS and K-wire groups. Two wound complications were observed in the PS group and one with K-wires.

CONCLUSION

Retrograde intramedullary K-wire fixation has certain advantages such as being less invasive and more accessible with shorter operation time, compared to PS fixation. Similar radiological and clinical scores can be obtained in patients undergoing retrograde intramedullary K-wire fixation or PS fixation.

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

BACKGROUND

Metacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure.

OBJECTIVE

To evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires.

MATERIALS AND METHODS

We used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force-displacement data. The Mann-Whitney U test was used to compare between-group differences in maximum fracture force and stiffness.

RESULTS

The maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p < 0.05; Figure 5a), with the median of the KP&F8 group exceeding that of the KP group by 57.5%. Similarly, stiffness was significantly lower in the KP group (18.14 ± 9.84 N/mm) than in the KP&F8 group (38.25 ± 23.49 N/mm; p < 0.05; Figure 5b), with the median of the KP&F8 group exceeding that of the KP group by 110.9%.

CONCLUSION

The incorporation of a figure-of-eight cerclage wire increased the maximum fracture force and stiffness by 57.5 and 110.9%, respectively, compared with those achieved in standard two K-wire fixation. Therefore, hand surgeons are advised to consider the proposed approach to increase fixation strength.

Joint line plate fixation for tibial plateau fractures caused by hyperextension varus

The present study evaluated the outcomes of internal fixation with a joint line plate in the treatment of tibial plateau fractures caused by hyperextension of the varus. The study included 25 cases (13 males and 12 females; age, 19-71 years) of tibial plateau fracture caused by hyperextension of the varus, which were treated at Puai Hospital, Tongji Medical College (Wuhan, China) between January 2015 and June 2017. Fractures were treated with internal fixations of the inner cortex with a self-clipped joint line plate made of steel. After the surgery, patients were examined immediately and at 3, 6 and 12 months. Healing was evaluated by X-ray examination. All cases were cured during follow-up. After surgery, one patient developed partial necrosis of the skin margin of the incision and recovered after a dressing change. Furthermore, one patient with a concomitant peroneal nerve injury and hypoesthesia recovered after treatment with neurotrophic drugs. No screw loosening, fractures or failure of the internal fixations occurred. According to the X-ray results, there were significant differences in the tibial plateau angle (TPA) and medial posterior slope angle (m-PSA) between the pre-operative stage and 12 months post-operatively (P<0.05). However, no significant differences in either the TPA or m-PSA were present between the immediate post-operative stage and 12 months post-operatively (P>0.05). In conclusion, internal fixation with a joint line plate is an appropriate treatment for tibial plateau fractures involving the anteromedial margin with good clinical efficacy.

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Background

Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.

Objective

We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.

Materials and methods

We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.

Results

The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.

Conclusion

Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Long-term outcomes of metacarpal fractures surgically treated using bioabsorbable plates: a retrospective study

Background

Implants made from bioabsorbable unsintered hydroxyapatite and poly-L-lactate composites (u-HA/PLLA) are widely used in the oral, maxillofacial, and orthopedic fields. This study assess the long-term (> 5 years) outcomes of patients with metacarpal fractures who were surgically treated using bioabsorbable plates and screws (Super-Fixsorb MX40 mesh; Teijin Medical Technology, Osaka, Japan).

Methods

A retrospective analysis of six patients with eight metacarpal fractures treated with bioabsorbable plates was done. All patients were followed for more than 5 years post-surgery. The clinical outcomes were evaluated using Q-DASH scores and the grip strength (GS): opposite side ratio. The resorption status of implants was assessed on plain computed tomography (CT) scans at final follow-up appointments.

Results

The mean age of the patients at the time of surgery was 29.5 years (16–54), and the median follow-up period was 81.8 months (68–101). All fractures united without displacement after an average of 3.5 months, and there were no implant specific complications associated with the use of absorbable plates. The mean grip strength ratio was 85.1% (56.8–104.5). The mean Q-DASH scores of 11.36 points (0–34.09) was good in all but two patients. We also observed that it took more than 8 years for the plates to be absorbed completely.

Conclusions

This study demonstrates that the process of bioabsorption in metacarpal fractures might be completed in about 8 years, and the absorption speeds were different inside and outside of the bone. The bioabsorbable plates are more cost-effective than metallic implants. The potential for bioabsorbable plates to be used in various clinical procedures is promising.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03841-x.

Pin vs plate fixation for metacarpal fractures: a meta-analysis

BACKGROUND

The differences in the clinical and functional outcomes of closed reduction and percutaneous pin fixation and open reduction with internal fixation (ORIF) using plate and screws have been systematically synthesized by one meta-analysis. With newer studies being published, an effort to update the earlier meta-analysis is necessary.

METHODS

Comprehensive searches were done systematically through PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google scholar databases. Randomized controlled trials, quasi-experimental studies, prospective comparative non-randomized studies, and even studies reporting findings from retrospective chart review were eligible to be included. Statistical analysis was done using STATA version 13.0. GRADE assessment was done to assess the quality of pooled evidence.

RESULTS

A total of 9 studies were included. The pooled estimates did not suggest any significant differences in the disabilities of the arm, shoulder, and hand (DASH) score [WMD - 0.77; 95% CI, - 3.55, 2.00; I² = 75.5%], range of movement (ROM) of the metacarpophalangeal joint (^o) [WMD 4.44; 95% CI, - 4.19, 13.07; I² = 86.0%], and grip strength [WMD - 4.63; 95% CI, - 14.52, 5.26; I² = 86.9%] among the two intervention modalities. No difference was seen in the risk of complications between the two interventions (RR 0.93; 95% CI, 0.57, 1.53; I² = 31.2%). For all the outcomes, the quality of pooled evidence was judged as low to very low.

CONCLUSION

No significant long-term differences were noted in the functional outcomes suggesting that both these techniques are comparable. The choice of modality should be made based on the skills and preference of the surgeon and availability of resources.

Comparison of low-profile locking plate fixation versus antegrade intramedullary nailing for unstable metacarpal shaft fractures--A prospective comparative study

BACKGROUND

The purpose of this study was to compare the effectiveness of mini-open antegrade intramedullary nailing (AIN) and open reduction and internal fixation (ORIF) using the low-profile locking plate for angulated metacarpal shaft fractures, through prospective comparative trial.

METHODS

Group 1 (mini-open AIN; 40 patients) and the other consecutive patients in group 2 (locking plate; 35 patients) who met our inclusion/exclusion criteria were investigated between January 2010 and December 2016. We compared radiological findings (e.g., union and residual angulation or shortening); clinical conditions (e.g., pain, measured on a visual analog scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores); active range of motion (ROM); and grip strength.

RESULTS

Union was achieved in both groups without any major complications. The final angulation measurements were not significantly different (p = 0.402). The final VAS scores were not different (p = 0.868); however, the final DASH score was better in group 1 than in group 2 (p = 0.034). The plates were removed in 14 patients at 9.6 months postoperatively for various reasons. Mean ROM at the time of hardware removal in these 14 patients was significantly lower compared with the final ROM in groups 1 and 2 (non-removal patients). Final grip strengths recovered significantly more in group 1 than in group 2 (p = 0.029). Extension lag was found in four patients in group 2, and the mean amount was 15°; however, it was resolved by tenolysis during hardware removal.

CONCLUSIONS

Both mini-open AIN and low-profile plate fixation are excellent options for metacarpal shaft fractures without significant radiological or clinical problems; however, some clinical outcomes evaluated at least 2 years postoperatively, such as DASH scores and grip strength, were better in the AIN group than in the locking plate group. Plate removal was performed under anesthesia in some patients in the plate group for various reasons, and this may have caused the small differences in the final outcomes evaluated 2 years after surgery.