Minimally Invasive Intramedullary Rod Fixation of Multiple Metacarpal Shaft Fractures

Balfour, George W

doi:10.1097/bth.0b013e31815678ef

Cited by 17 publications

(13 citation statements)

References 4 publications

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“…The rotational stability and lack of requisite hardware removal are improvements over previously described intramedullary nail techniques for metacarpal fractures. 20 Biomechanically, the fixation strength of intramedullary devices and multiple K-wire fixation are comparable. 21 Additional benefits to this technique include early mobilization (typically within 5 days) with subsequent rapid recovery of motion and function.…”

Section: Discussionmentioning

confidence: 97%

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

2016

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BackgroundThere is a lack of consensus on optimal treatment methods for operative fixation of metacarpal fractures. 1 Classic treatment options include plate and screw fixation or percutaneous fixation with Kirschner wires (K-wires). 1,2 For subcapital fractures or those fractures involving the metacarpal neck, the lack of distal purchase can preclude plate and screw fixation. Short oblique, transverse, comminuted, or multiple metacarpal shaft fractures typically require more rigid fixation with lag screws or plate and screw constructions. Plate and screw fixation can be associated with considerable metacarpophalangeal stiffness, necessitating secondary implant removal and joint release. While K-wire fixation for metacarpal fractures often results in bony union, it necessitates a period of immobilization and has a complication rate up to 16%. 3,4 Bouquet pinning with intramedullary wires placed in an antegrade manner can often be satisfactory but requires immobilization, future implant removal, and may not always offer secure fixation or rotational control. 5 Periarticular fractures of the upper extremity can be reliably treated with buried intra-articular fixation. 6-14 This series presents the clinical results of a relatively new technique of fixation for metacarpal fractures using retrograde intramedullary headless screws (IMHS) that allows early mobilization with minimal complications. Keywords► metacarpal fracture ► intramedullary fixation ► headless compression screw ► minimally invasive AbstractIntroduction 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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Section: Discussionmentioning

confidence: 97%

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

2016

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“…Quality of fixation is of utmost importance because fractured metacarpals are prone to angulation and shortening, which can be particularly problematic with unstable or comminuted fractures. 24 A recent study demonstrated that intramedullary nailing of extra-articular metacarpal fractures was associated with a much higher incidence of loss of reduction, penetration into the metacarpophalangeal joint, and follow-up procedures for removal of hardware compared with plate and screw fixation. 25 Other studies have similarly shown plate and screw fixation to be superior among the internal fixation techniques.…”

Section: Discussionmentioning

confidence: 98%

Biomechanical Comparison of Double-Row Locking Plates Versus Single- and Double-Row Non-Locking Plates in a Comminuted Metacarpal Fracture Model

Gajendran

Szabo

Myo

et al. 2009

The Journal of Hand Surgery

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“…However, the disadvantages of the abovementioned method in our setup included the use of the required instrumentation which was not routinely available and was prohibitively expensive. Also there have been concerns by some authors about the locking device needed in that technique due to the fact that it is a bit difficult to use and also because of its undue prominence under the skin [1]. Hence, the authors designed this cheap and locally designed method of locked nailing of metacarpal fractures (the approximate cost of the implants with the K-wires was not more than $5-10).…”

Section: Discussionmentioning

confidence: 99%

A New Technique of Locked, Flexible Intramedullary Nailing of Spiral and Comminuted Fractures of the Metacarpals: A Series of 21 Cases

Agashe¹,

Phadke²,

Agashe³

et al. 2011

Hand (New York, N,Y.)

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Background Spiral and comminuted fractures of the metacarpals are rotationally and axially unstable fractures with a tendency to shorten, which in turn causes significant extensor lag and loss of grip strength. We have designed a new, cheap and locally developed method of locked intramedullary nailing of these metacarpal fractures. We are presenting the results of our first 21 patients with 22 fractures treated by closed, fluoroscopically assisted, intramedullary K-wiring with proximal locking done by a specially designed locking pin. Materials and Methods This was a retrospective, observational cohort study of all patients with spiral and comminuted fractures of metacarpals with minimum of 1 year of follow-up and average follow-up of 14 months (range, 12 to 26 months). The patients were evaluated clinico-radiologically using range of motion, extensor lag, time to healing, amount of collapse, angulation and rotation and complications. Results All fractures had healed uneventfully with average time to union being 8 weeks. Average metacarpal shortening was 2.04±0.95 mm, while the average post-operative angulation of the fracture was 4.81°±1.7. The metacarpophalangeal range-of-motion recovered almost fully with the average extensor lag being only 5.22°±2.42. Other than extensor tendinitis in two patients, there were no other complications.Conclusions This method is cosmetically appealing, provides stable fixation, avoids periosteal stripping associated with open reduction and is associated with very low complication rate, and thus can be safely and effectively used for the treatment of these difficult fractures.

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Minimally Invasive Intramedullary Rod Fixation of Multiple Metacarpal Shaft Fractures

Cited by 17 publications

References 4 publications

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

Biomechanical Comparison of Double-Row Locking Plates Versus Single- and Double-Row Non-Locking Plates in a Comminuted Metacarpal Fracture Model

A New Technique of Locked, Flexible Intramedullary Nailing of Spiral and Comminuted Fractures of the Metacarpals: A Series of 21 Cases

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