Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws

Trévisan, C.; Morganti, Alessandro; Casiraghi, Alessandro; Marinoni, E. C.

doi:10.1007/s00402-004-0745-7

Cited by 59 publications

(41 citation statements)

References 21 publications

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“…(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) A study by Souer et al (33) showed good functional outcome by total active motion more than 230 0 in 18 of 19 patients for whom plate fixation was done in closed unstable metacarpal fractures. Another study by Gupta et al (11) showed excellent functional outcome with total active movements more than 230 0 in all of his patients of unstable metacarpal fractures treated with plate fixation.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome of Closed Metacarpal Fractures Treated With Mini Fragment Plates and Screws

Pugalenthi¹,

K²,

Thanappan³

et al. 2017

jemds

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BACKGROUNDMetacarpal fractures are common in adolescents and young active individuals. Mostly these are treated by conservative methods. In unstable fractures where closed reduction and final outcome are unsatisfactory, there are multiple surgical options for treating metacarpal fractures like K-wire fixation, interosseous wiring, plate osteosynthesis, etc. In this study, we assess functional outcome of closed metacarpal fractures treated with plates and screws. MATERIALS AND METHODSBetween 2014 and 2016, 20 cases of closed metacarpal fractures were studied. Fracture was approached by dorsal incision. Plate configurations were chosen according to the fracture pattern (straight plate for shaft fractures, T or L configured plates were used for periarticular fractures) and fixed with screws. Post-operative physiotherapy and followup carried out. RESULTSIn our study, all the cases showed bone union (100%). The functional result assessed by American Society for Surgery of the Hand (ASSH) Total Active Flexion score showed excellent result in 80% of the patients (16 of 20 cases), good in 10% of cases (2 of 20 cases). Stable and rigid fixation allowed early mobilisation of fingers thereby preventing stiffness and achieved overall good functional results. Although there were 10% (2 cases) of superficial infections, all settled with regular dressing and antibiotics without affecting final functional outcome. The overall results are satisfactory. CONCLUSIONPlate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective. The rigid stable fixation provided by plating which withstands load without failure allowed early mobilisation and achieved good functional results.

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Section: Discussionmentioning

confidence: 99%

Functional Outcome of Closed Metacarpal Fractures Treated With Mini Fragment Plates and Screws

Pugalenthi¹,

K²,

Thanappan³

et al. 2017

jemds

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“…Furthermore, these procedures are costly, require special equipment (24,28) and may not necessarily improve power recovery beyond what is achieved using a conservative approach. In a review of 45 metacarpal fractures stabilized via ORIF using miniature plates or screws, Trevisan et al (28) reported a mean grip strength reduction of 3.2±10.1%, which remained stable at two years postfracture; furthermore, a 31.1% complication rate resulted. Westbrook et al (13) noted no significant difference in grip strength measurements following little finger metacarpal shaft fractures that were either treated with ORIF via plate or K-wire fixation, or conservatively with no attempt at reduction.…”

Section: Figure 1) X-rays Revealing Displacement In 12 Of the 13 Patimentioning

confidence: 99%

“…The results obtained from the current study support others in the literature (9,10,16) that demonstrate that the loss of metacarpal length associated with these fractures is limited to a degree of shortening that is not consistent with power deficits sufficiently large to significantly affect functional recovery in the hand. Furthermore, a review of grip strength outcomes following various approaches to internal fixation has revealed results similar to those obtained via conservative techniques (13,16,28). A properly performed prospective randomized controlled trial of conservative versus surgical management outcome on power is warranted.…”

Section: Figure 1) X-rays Revealing Displacement In 12 Of the 13 Patimentioning

confidence: 99%

“…Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss.…”

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confidence: 99%

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Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

et al. 2014

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Metacarpal fractures are among the more common fractures of the upper extremity (1-7), accounting for 18% of all below-elbow fractures in the United States (5). Freehan and Sheps (8) reported that metacarpal fractures represented 42% of 72,481 reviewed cases of hand fractures. Spiral metacarpal fractures commonly result in some shortening of the metacarpal shaft (9), which may subsequently cause extension lag at the metacarpophalangeal (MCP) joint and reduced grip strength (9-13). Several studies have documented the relationship between shortening and hand function (1,9,12,(14)(15)(16)(17)(18)(19)(20)(21), although the maximum amount of shortening that occurs following metacarpal fracture and acceptable limits appear to be controversial.Historically, spiral fractures occurring without scissoring have been treated surgically to restore metacarpal length and prevent these losses in power and function. Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss. Furthermore, one must consider the cost, complications and consequences associated with surgery, postoperative management and wound healing.Increasingly, conservative management of nonscissoring spiral metacarpal fractures has come into favour in the absence of absolute indications for a surgical approach (10,11,16,32). Despite potential shortening of the metacarpal, a nonoperative approach preserves the integrity of the intrinsic muscles of the hand, thereby benefiting functional recovery, while also avoiding the aforementioned consequences and costs of surgery. Unfortunately, however, few studies exist documenting the long-term natural history of unoperated spiral metacarpal fractures. The purpose of the present study was, therefore, to investigate this outcome.We conducted a prospective consecutive case series of unoperated, nonscissoring spiral metacarpal fractures to document the effect of conservative management on resultant power in the hand despite the metacarpal shortening that is often associated with these fractures. BACKgROUND: Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand. OBJECTIVE: To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures. METHODS: Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural histor...

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“…Implantate (z. B. VariAx™ Hand, Profyle Hand und Kombimodule der Firma Stryker®, Aptus® Hand oder winkelstabile Handminiplatten der Firma Königsee-Implantate®) zur Verfügung stehen [3,17,19]. Wir verwenden an unserer Klinik das oben genannte Implantat aus logistischen bzw.…”

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Osteosynthese von Metakarpalefrakturen mit 2,0-mm-LCP und funktionelle postoperative Nachbehandlung

et al. 2015

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Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws

Abstract: These very favourable results suggest that miniature plates and screws are a possible choice in the treatment of these fractures.

Cited by 59 publications

References 21 publications

Functional Outcome of Closed Metacarpal Fractures Treated With Mini Fragment Plates and Screws

Functional Outcome of Closed Metacarpal Fractures Treated With Mini Fragment Plates and Screws

Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

Osteosynthese von Metakarpalefrakturen mit 2,0-mm-LCP und funktionelle postoperative Nachbehandlung

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