Percutaneous Distraction Pinning for Metacarpophalangeal Joint Stabilization After Blast or Crush Injuries of the Hand

Abstract

Background Unstable, severely comminuted fractures of the metacarpophalangeal (MCP) joint are difficult to treat. Closed treatment and casting of these fractures often fail to maintain proper alignment and impede wound care where concomitant open injuries such as gunshot wounds are present. Conventional pinning or plating techniques are not feasible if extensive bone loss and comminution are present. A distraction pinning technique represents a potential alternative, but results with this approach, to our knowledge, have not been reported. Questions/purposes The purposes of this study were (1) to evaluate the effectiveness (defined as osseous union and joint stability) of distraction pinning for comminuted fractures involving MCP joints after gunshot or crush injuries; (2) to report the short-term results in terms of pain and function in a small group of patients who underwent MCP distraction pinning; and (3) to evaluate complications and return to work status of these patients in the short term. Methods We reviewed 10 patients with comminuted pilon-type fractures of the base of the proximal phalanx or metacarpal head treated with wire distraction fixation from 2005 and 2014. During that period, we used this technique to treat all patients whose fractures were deemed too comminuted for plating or pinning, and during that period, no other techniques (such as simple external fixation) were used for patients meeting those indications. The minimum followup was 6 months; eight of the 10 patients were accounted at a median of 10 months (range, 6-89 months). The median age was 47 years (range, 28-57 years), and seven of the eight were male. Kirschner wire fixation frames were removed 3.5 to 6 weeks after the index surgery when fracture consolidation was confirmed on radiography by the treating surgeon. Stability and range of motion of the MCP joint were assessed using physical examination, radiographs, and goniometer by the treating surgeon. Patients completed the Quick Disabilities of the Arm, Shoulder and Hand score at latest followup or by telephone, and complications were assessed by chart review.

A Fourteen-year Review of Practice Patterns and Evidence-based Medicine in Operative Metacarpal Fracture Repair

“…16,20,21 In the most severe cases where bone loss or soft-tissue compromise is present, external fixation techniques may be used. 22,23…”

“…16,20,21 In the most severe cases where bone loss or soft-tissue compromise is present, external fixation techniques may be used. 22,23 Additional operative approaches with nonspecific indications include closed reduction and percutaneous pinning with Kirschner wires, as well as open reduction and internal fixation with miniplates. 24…”

Arthroplasty for Treating Traumatic Metacarpophalangeal Joint Defects: A Retrospective Study Over Three Years

“…Implant fractures lead to loss of function, which is our primary consideration when using orthosis instead of arthroplasty alone. Langford et al 23 showed that the distraction pinning technique provides reliable osseous union and joint stability of the metacarpal head. This technique is similar to our joint orthosis technique.…”

Arthroscopic Assistance and Percutaneous Fixation of Complex Intraarticular Metacarpophalangeal Fracture

“…Intraarticular metacarpophalangeal (MCP) fractures are complex and pose a challenge to the hand surgeon. 1,2 There are multiple techniques described for the treatment of these fractures that frequently require surgery since they occur with displacement or comminution which make anatomical reduction and stabilization necessary. [1][2][3][4][5][6][7][8] Arthroscopic techniques for small joints have been developed greatly in the last 40 years since their description.…”

“…1,2 There are multiple techniques described for the treatment of these fractures that frequently require surgery since they occur with displacement or comminution which make anatomical reduction and stabilization necessary. [1][2][3][4][5][6][7][8] Arthroscopic techniques for small joints have been developed greatly in the last 40 years since their description. [9][10][11] There is growing evidence to suggest that small joint arthroscopy can be a safe and valuable tool in the management of comminuted head metacarpal fractures and intraarticular base of phalanges fractures.…”