Metacarpal Fractures: Treatment and Complications

Kollitz, Kathleen M.; Hammert, Warren C.; Vedder, Nicholas B.; Huang, Jerry I.

doi:10.1007/s11552-013-9562-1

Cited by 171 publications

(201 citation statements)

References 50 publications

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“…Different types of studies demonstrate that treatment of this injury consists of a closed reduction of the fracture and immobilization with cast application (21,22). This treatment is suitable for nondisplaced or minimally displaced fracture without rotational deformity (23). However, long-term cast immobilization limits the activities of the patients and may lead to a stiff joint and pressure necrosis of the skin, thus prolonging rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

Shen

Cao

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The purpose of the current study was to assess the outcome of antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced fifth metacarpal neck fractures. The present study included 69 consecutive juvenile patients with displaced fifth metacarpal fractures. The head-shaft angle of the fifth metacarpal and range of motion (ROM) of the metacarpophalangeal (MCP) joint were evaluated. A disabilities of the arm, shoulder and hand (DASH) questionnaire was used to assess upper arm function. The head-shaft angle of the affected side was significantly improved postoperatively (P<0.05). No marked difference was observed between the affected and unaffected side in head-shaft angle and ROM. The average DASH score was 1.7 (range, 0-6.0). All patients obtained anatomical reduction postoperatively and the average healing time was 5.7±1.09 weeks (range, 5-10 weeks) with no non-union cases. Therefore antegrade intramedullary fixation with TEN is recommended as an easy, reliable and minimally invasive surgical technique for treating displaced fifth metacarpal neck fractures.

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Section: Discussionmentioning

confidence: 99%

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

Shen

Cao

et al. 2017

Experimental and Therapeutic Medicine

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“…Notably, the angular criteria for surgical intervention is highly variable with some authors accepting up to 700 of angulation (8, 18, 30). The acceptable degree of angulation increases for the more ulnar digits owing to the compensatory movement of the 4th and 5th carpometacarpal joints.…”

Section: Resultsmentioning

confidence: 99%

Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques

et al. 2016

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ContextHand injuries are a common emergency department presentation. Metacarpal fractures account for 40% of all hand fractures and can be seen in the setting of low or high energy trauma. The most common injury pattern is a metacarpal neck fracture. In this study, the authors aim to review the surgical indications for metacarpal neck fractures, the fixation options available along with the risk and benefits of each.Evidence AcquisitionLiterature review of the different treatment modalities for metacarpal neck fractures. Review focuses on surgical indications and the risks and benefits of different operative techniques.ResultsThe indications for surgery are based on the amount of dorsal angulation of the distal fragment. The ulnar digits can tolerate greater angulation as the radial digits more easily lose grip strength. The most widely utilized fixation techniques are pinning with k-wires, dorsal plating, or intramedullary fixation. There is currently no consensus on an optimal fixation technique as surgical management has been found to have a complication rate up to 36%. Plate and screw fixation demonstrated especially high complication rates.ConclusionsMetacarpal neck fractures are a common injury in young and active patients that results in substantial missed time from work. While the surgical indications are well-described, there is no consensus on the optimal treatment modality because of high complication rates. Dorsal plating has higher complication rates than closed reduction and percutaneous pinning, but is necessary in comminuted fractures. The lack of an ideal fixation construct suggests that further study of the commonly utilized techniques as well as novel techniques is necessary.

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“…In setting metacarpal fractures, the flexor tendons can lead to volar angulation of the distal fragment. This may also account for increased incidence of screw loosening seen in the distal fragment [8] . Since the angle of the metacarpals is in the same direction as the flexion force, it may contribute to volar displacement as well as screw loosening.…”

Section: Discussionmentioning

confidence: 99%

Degree and location of metacarpal angulations

Bhandari¹,

Sathekga²,

Aguilar³

et al. 2017

PAR

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Aim:Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy. These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°; SD, 4.73), 3rd = 10° (range, 1-25°; SD, 5.28), 4th = 11° (range, 1-20°; SD, 4.45), 5th = 12° (range, 2-24°; SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger, 52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion: These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy. ABSTRACT

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Metacarpal Fractures: Treatment and Complications

Cited by 171 publications

References 50 publications

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques

Degree and location of metacarpal angulations

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