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Dunleavy ML, Candela X, Darowish M. Morphological Analysis of Metacarpal Shafts With Respect to Retrograde Intramedullary Headless Screw Fixation. Hand (N Y) 2022; 17:602-608. [PMID: 32666845 PMCID: PMC9274869 DOI: 10.1177/1558944720937362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The use of retrograde intramedullary headless compression screw fixation for metacarpal neck and shaft fractures has been described in the literature. The purpose of this study was to perform a computed tomography (CT)-based morphological analysis of metacarpal size to help surgeons anticipate expected hardware needs. Methods: In all, 108 consecutive hand CT scans were evaluated for the medullary diameter in the volar-dorsal and radial-ulnar planes at the narrowest point of the canal, as well as for the distance from the articular surface to this point. Results were then analyzed by finger and by sex. Results: The ring finger had the smallest average medullary canal diameter for both men and women (2.7 and 2.6 mm, respectively); the small finger had the largest average diameter (3.9 mm) for men and the middle finger (3.6 mm) for women. Radial-ulnar was the rate-limiting dimension in the index, middle, and ring fingers, whereas volar-dorsal was the smallest dimension in the small finger, regardless of sex. Medullary diameter tended to be larger in patients aged more than 50 years. More than 50% of fingers have diameters >3.0 mm, and at least 40% of index, middle, and small fingers have diameters >3.5 mm, which are common diameters of commercially available headless compression screws. Conclusions: When preparing to perform open reduction internal fixation of a metacarpal using retrograde intramedullary headless compression screws, the surgeon needs to be prepared with screws of larger diameters to optimize fixation. Screws of larger diameters are needed to achieve endosteal purchase, regardless of sex.
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Affiliation(s)
| | - Xavier Candela
- Penn State Health Milton S. Hershey Medical Center, PA, USA
| | - Michael Darowish
- Penn State Health Milton S. Hershey Medical Center, PA, USA,Michael Darowish, Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2400, Building B, PO Box 859, Hershey, PA 17033, USA.
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Blackburn J, Johnson N, Pocnetz S, Lindau TR. Effective Treatment of Simultaneous Distal Radius and Scaphoid Fractures. J Wrist Surg 2022; 11:89-94. [PMID: 35127271 PMCID: PMC8807087 DOI: 10.1055/s-0041-1726308] [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: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Background There is an increasing trend for most surgeons to choose open reduction and internal fixation of simultaneous distal radius and scaphoid fractures; however, it is not clear if there is any evidence to support this. Case Description The purpose of this systematic review was to investigate the evidence for management of simultaneous distal radius and scaphoid fractures. Literature Review We performed searches of the EMBASE and MEDLINE databases (CRD42020167403). We included a total of 20 studies, involving 178 patients with 182 simultaneous fractures of the distal radius and scaphoid. The distal radius fractures were mostly intra-articular (112/182). The scaphoid fractures were mostly undisplaced (120/148) and at the scaphoid waist (152/178). All distal radius fractures went on to unite, and just 2 of 182 scaphoid fractures went on to nonunion. All included studies were retrospective case series, and therefore all were found to have a critical risk of bias due to confounding. The union rate for both the distal radius and scaphoid fractures is high with both operative and nonoperative treatments. Clinical Relevance Although there are no comparative studies to evaluate the most effective treatment, there is evidence to support operative management. Level of Evidence This is a Level IV, systematic review study.
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Affiliation(s)
- Julia Blackburn
- The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom
| | - Nick Johnson
- The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom
| | - Sasa Pocnetz
- The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom
| | - Tommy R. Lindau
- The Pulvertaft Hand Centre, Royal Derby Hospital, Derby, United Kingdom
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Sugiyama Y, Naito K, Obata H, Kinoshita M, Goto K, Nagura N, Iwase Y, Kaneko K. Does pisiform subluxation affect the postoperative outcomes in a cohort of patients with distal radius fractures? Ann Med Surg (Lond) 2018; 35:73-75. [PMID: 30294433 PMCID: PMC6170207 DOI: 10.1016/j.amsu.2018.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/21/2018] [Accepted: 09/21/2018] [Indexed: 12/02/2022] Open
Abstract
Background In this study, we retrospectively surveyed the presence or absence of pisiform subluxation in surgically treated distal radius fractures (DRF) cases. In addition, we investigated whether or not the postoperative short-term treatment outcome differs due to the presence of pisiform subluxation. Materials and methods The subjects were 134 DRF patients treated with volar locking plate fixation (53 males and 81 females, mean age: 64 years old). The pisotriquetral joint was observed on a preoperative CT to investigate the presence or absence of pisiform subluxation according to the criteria reported by Vasilas. 134 patients divided into subluxation group and non-subluxation group, and the clinical outcomes were compared between these groups. Results Pisiform subluxation was noted in 23.1% (31 patients, 15 males and 16 females, mean age 61 years). No significant difference was noted in patient background in both groups. The postoperative pronation angle in the non-subluxation group was significantly greater than that in the subluxation group, but there was no significant difference in any other parameter (the range of motion of the wrist, grip strengths, VAS, Q-DASH scores, and Mayo score) between these 2 groups. However it concomitantly occurred in 23.1% of DRF cases in our series, there was no significant difference in the postoperative treatment outcome between these 2 groups. Conclusions Therapeutic intervention of pisiform subluxation is unnecessary during treatment of DRF, since pisiform subluxation does not affect the postoperative clinical outcomes of distal radius fractures. Pisiform subluxation occurred in 23.1% of distal radius fracture cases, suggesting that it is not a rare pathology. Therapeutic intervention of pisiform subluxation may be unnecessary during treatment of distal radius fracture. The therapeutic intervention of pisotriquetral joint disorders should be considered when they develop.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Gürbüz Y, Sügün TS, Kayalar M. Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists). J Wrist Surg 2018; 7:11-17. [PMID: 29383270 PMCID: PMC5788761 DOI: 10.1055/s-0037-1603319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19-82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert-Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12-97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0-8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.
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Affiliation(s)
- Yusuf Gürbüz
- Department of Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Kahramanlar-İzmir, Turkey
| | - Tahir Sadık Sügün
- Department of Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Kahramanlar-İzmir, Turkey
| | - Murat Kayalar
- Department of Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Kahramanlar-İzmir, Turkey
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Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study. J Hand Surg Am 2017; 42:392.e1-392.e6. [PMID: 28359640 DOI: 10.1016/j.jhsa.2017.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/24/2017] [Accepted: 02/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. METHODS Eight matched-paired hands (n = 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. RESULTS Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). CONCLUSIONS Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. CLINICAL RELEVANCE Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neck fractures.
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Dumontier C, Carmès S, Kadji O. [Combined scaphoid and distal radius fractures in adults]. HAND SURGERY & REHABILITATION 2016; 35S:S55-S59. [PMID: 27890213 DOI: 10.1016/j.hansur.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/26/2016] [Accepted: 05/25/2016] [Indexed: 10/20/2022]
Abstract
Although isolated distal radius and scaphoid fractures are common, the combination of both fractures is rare, with a reported frequency between 0.5% and 6%. This rarity is probably due to the fact that both fractures share the same injury mechanism. Published studies are limited, but most patients are males in their 40s and the injuries are typically due to high-energy trauma. In most studies, the distal radius fracture is displaced while the scaphoid fracture is not. Since the functional outcome depends of the severity of the radius fracture, we believe, as do others, that it is logical to fix both fractures with stable devices (i.e., screw fixation for the scaphoid, locking plate for the radius) to allow for early rehabilitation.
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Affiliation(s)
- C Dumontier
- Urgences main Guadeloupe, clinique les eaux claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe.
| | - S Carmès
- Urgences main Guadeloupe, clinique les eaux claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe
| | - O Kadji
- Urgences main Guadeloupe, clinique les eaux claires, ZAC Moudong Sud, 97122 Baie-Mahault, Guadeloupe
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Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws. J Hand Microsurg 2016; 8:134-139. [PMID: 27999455 DOI: 10.1055/s-0036-1593390] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022] Open
Abstract
Introduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.
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Affiliation(s)
- Daniel G Tobert
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Melissa Klausmeyer
- Department of Plastic Surgery, University of Southern California, Los Angeles, California, United States
| | - Chaitanya S Mudgal
- Department of Orthopaedic Surgery, Orthopaedic Hand Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abutalib RA, Khoshhal KI. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:6-11. [PMID: 26732673 PMCID: PMC4708097 DOI: 10.12659/ajcr.894984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 36 Final Diagnosis: Multiple concomitant right upper limb fractures Symptoms: — Medication: — Clinical Procedure: Open reduction and internal fixation of right upper limb fractures Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Raid A Abutalib
- Department of Orthopedic Surgery, King Fahad Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Khalid I Khoshhal
- Department of Orthopedic Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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9
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Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am 2014; 39:2390-5. [PMID: 25240434 DOI: 10.1016/j.jhsa.2014.08.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical and radiographic outcomes in patients treated with limited-open retrograde intramedullary headless compression screw (IMHS) fixation for metacarpal neck and shaft fractures. METHODS Retrospective review of prospectively collected data on a consecutive series of 39 patients (34 men; 5 women), mean age 28 years (range, 16-66 y) treated with IMHS fixation for acute displaced metacarpal neck/subcapital (N = 26) and shaft (N = 13) fractures at a single academic practice between 2010 and 2014. Preoperative magnitude of metacarpal neck angulation averaged 54° (range, 15° to 70°), and shaft angulation averaged 38° (range, 0° to 55°). Patients used a hand-based orthosis until suture removal and began active motion within the first week. Clinical outcomes were assessed with digital goniometry, pad-to-distal palmar crease distance, and grip strength. Time to union and radiographic arthrosis was assessed. Twenty patients reached minimum 3-month follow-up, with a mean of 13 months (range, 3-33 mo). RESULTS All 20 patients with minimum 3 months of follow-up achieved full composite flexion, and extensor lag resolved by 3-week follow-up. All patients demonstrated full active metacarpophalangeal joint extension or hyperextension. Grip strength measured 105% (range, 58% to 230%) of the contralateral hand. No secondary surgeries were performed. There were 2 cases of shaft re-fracture from blunt trauma following prior evidence of full osseous union with the screw in place. All patients achieved radiographic union by 6 weeks. There was no radiographic arthrosis at latest follow-up. One patient reported occasional clicking with metacarpophalangeal joint motion not requiring further treatment. CONCLUSIONS Limited open retrograde IMHS fixation proved to be safe and reliable for metacarpal neck/subcapital and axially stable shaft fractures, allowed for early postoperative motion without affecting union rates, and obviated immobilization. This technique offers distinct advantages in select patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- David E Ruchelsman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA.
| | - Sameer Puri
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Natanya Feinberg-Zadek
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Matthew I Leibman
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
| | - Mark R Belsky
- Hand Surgery, P.C., Newton, MA; Newton-Wellesley Hospital/Tufts University School of Medicine, Boston, MA
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Heo YM, Kim SB, Yi JW, Lee JB, Park CY, Yoon JY, Kim DH. Evaluation of associated carpal bone fractures in distal radial fractures. Clin Orthop Surg 2013; 5:98-104. [PMID: 23730472 PMCID: PMC3664678 DOI: 10.4055/cios.2013.5.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). Methods Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. Results CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs. Conclusions Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.
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Affiliation(s)
- Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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11
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Wrist fractures in adults: getting a grip. Nursing 2013; 43:38-45; quiz 46. [PMID: 23455036 DOI: 10.1097/01.nurse.0000427986.39188.a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ten Berg PWL, Mudgal CS, Leibman MI, Belsky MR, Ruchelsman DE. Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am 2013. [PMID: 23200214 DOI: 10.1016/j.jhsa.2012.09.029] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-dimensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. METHODS We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm(2)) and subchondral volumes (mm(3)) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. RESULTS Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm(2); through the coronal plane arc (45°) was 129 mm(2), and through the sagittal plane arc (120°) was 265 mm(2). The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm(3). Mean subchondral volume occupied by the countersunk portion was 4%. The phalangeal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc. During coronal plane motion in neutral extension, the center of the base never engaged the dorsally located countersunk entry site. CONCLUSIONS Metacarpal head surface area and subchondral head volume occupied by HCS were minimal. Articular surface area violation was least during the more clinically relevant sagittal plane arc of motion. CLINICAL RELEVANCE The dorsal articular starting point was in line with the medullary canal and avoided engaging the center of the articular base through most of the sagittal plane arc. Three-dimensional computed tomography data support the use of an articular starting point for these extra-articular fractures.
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Affiliation(s)
- Paul W L ten Berg
- Hand and Upper Extremity Surgery Service, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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13
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Gardner S, Ruchelsman D, Mudgal C. Concomitant high-energy fractures of the distal radius and hook of hamate. J Hand Surg Eur Vol 2012; 37:366-7. [PMID: 22290881 DOI: 10.1177/1753193411436293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Gardner
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
| | - D Ruchelsman
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
| | - C Mudgal
- Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
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Abstract
There has been a surge in the operative management of distal radius fractures. Closed reduction, external fixation, and open reduction with internal fixation each have advantages and disadvantages. The purpose of this review is not to provide the clinician with an algorithm for treatment of distal radius fractures. These fractures span an extensive spectrum of severity across age groups and demographics. Fortunately, the surgeon holds a vast array of options to provide care for patients with distal radius fractures. The choice of fixation or conservative care resides in the personality of the fracture and the needs of the patients.
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Affiliation(s)
- Joshua G Bales
- Hand Surgery Specialists, Inc, 538 Oak Street, Cincinnati, OH 45219, USA.
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15
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Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010; 35:1260-3. [PMID: 20619555 DOI: 10.1016/j.jhsa.2010.04.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 04/24/2010] [Accepted: 04/28/2010] [Indexed: 02/02/2023]
Abstract
This case report describes an alternative technique for the fixation of displaced comminuted subcapital fractures of the metacarpal with limited distal bone stock. Using a cannulated headless screw as an intramedullary device placed through the articular surface, we were able to secure proximal and distal bone purchase without excessive soft tissue stripping or disruption of the fracture hematoma. This technique allows early rehabilitation, and our patient went on to uneventful healing with excellent functional results.
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Affiliation(s)
- Christina L Boulton
- Harvard Combined Orthopaedic Residency Program and Department of Orthopaedic Surgery, Harvard Medical School, Orthopaedic Hand Service, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Background: Wrist injuries are common in sports. Those who are involved in the care of athletes should be familiar with hand and wrist anatomy, common wrist injuries, and clinical examination; they should also know how to recognize emergent problems. Level of Evidence: Level V, expert opinion.
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