Percutaneous Fixation of First Metacarpal Base Fractures Using Locked K-Wires

Adi, Mohamed; Miyamoto, Hideaki; Taleb, C.; Zemirline, A.; Gouzou, S.; Facca, S.; Liverneaux, Philippe

doi:10.1097/bth.0000000000000040

Cited by 30 publications

(24 citation statements)

References 16 publications

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“…43 The VAS and the Q-DASH score have been used in studies evaluating the effects of surgery to the thumb CMC joint to quantify postoperative pain and functional outcomes, respectively. [44][45][46][47][48] Day et al 37 have studied the short-and long-term effects of thumb CMCJ steroid injections and splinting on patients suffering from progressively worse stages of the disease. They have demonstrated an average 23 months of pain relief for all patients at the first stage, long-term efficacy in only 40% of those with stages II and III and lack of either short-or long-term relief in those with stage IV.…”

Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial

et al. 2018

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Various systematic reviews have recently shown that intra-articular platelet-rich plasma (IA-PRP) can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb. A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III according to the Eaton and Littler classification) was conducted. Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval. Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient’s subjective satisfaction. No significant differences between the baseline clinical and demographic characteristics of the 2 groups were identified. After 12 months’ follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score ( P = 0.015), Q-DASH score ( P = 0.025), and patients’ satisfaction ( P = 0.002). Corticosteroids offer short-term relief of symptoms, but IA-PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic TMJ arthritis.

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Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial

et al. 2018

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“…With the development of arthroscopy, some doctors prefer arthroscopic reduction and internal fixation [17,18]. There are various methods of fixation: pins [3][4][5][6]19], screws [17,20], plates [9,21], tension bands [22,23], and external fixator [24]. Most researchers believed that anatomic congruity is more important than fracture fixation technique for longterm success.…”

Section: Discussionmentioning

confidence: 99%

“…It is for this reason that surgical management is generally recommended for displaced intraarticular fractures to the proximal aspect of the thumb metacarpal. Closed reduction and percutaneous fixation is most widely used method for Bennett's fracture [3][4][5][6]. Following closed reduction and percutaneous fixation, fluoroscopic imaging can be used to assess the reduction.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Yin

Wang

et al. 2021

BMC Musculoskelet Disord

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Background Restoration of joint congruity is an important factor for the prevention of subsequent arthritis in patients with Bennett’s fracture. Surgical treatment of Bennett’s fracture is thus generally recommended for displaced intra-articular fractures to the proximal aspect of the thumb metacarpal. Fluoroscopic examination is used to evaluate the adequacy of closed reduction after pinning of Bennett’s fracture. The purpose of this study was to determine the accuracy of fluoroscopy to determine the reduction of Bennett’s fractures. Methods A model was created, to mimic a Bennett’s fracture utilizing ten fresh-frozen cadaveric hands. An oblique cut was made in the proximal aspect of the thumb metacarpal using an oscillating saw. The small oblique fragment involved 1/4–1/3 of the joint surface was then shifted in position creating a step-off or gap at the fracture site. An anatomical reduction model, gap models (1 mm, 2 mm, 3 mm), and step-off models (1 mm, 2 mm, 3 mm) were created using percutaneous fixation with two 1.0 mm Kirschner wires for each cadaveric hand. Fluoroscopic assessment then took place and was reviewed by 2 attending hand surgeons blinded to the actual position. Their estimated fluoroscopic position was then compared to the actual displacement. Results The step-off and gap on fluoroscopic examination showed a significant difference compared to the step-off and gap from direct visualization. The frequency of underestimation for the 3 mm displacement models from the fluoroscopic examination was 60%. The frequency for overestimated was 9% for the models in which displacement was within 2 mm (0, 1, 2 mm). Conclusions The assessment of articular gap and step-off using PA (postero-anterior), AP (antero-posterior), and lateral view of fluoroscopic examination is not accurate as compared to the examination by direct visualization. Surgeons need to be aware that PA, AP and lateral view of fluoroscopic examination alone may not be sufficient to judge the final position of a reduced Bennett’s fracture. Other methods such as live fluoroscopy in multiple different planes, 3-dimensional fluoroscopy or arthroscopic examination should be considered.

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“…For the RW-C fractures, the distal part fragment of fracture moves toward the second metacarpal and hides into thenar. Manual closed reduction of RW-C fracture needs axial traction on the thumb and pressure is placed on the base of the distal fragment [12]. Both of the second metacarpal and thenar hider impact the manual closed reduction.…”

Section: Discussionmentioning

confidence: 99%

“…This is why the Iselin method was proposed [21]. Some researchers reported the incidence of secondary displacement because of faulty Iselin technical approach and the loss of the maintaining the quality of reduction [12]. Wiggins preferred the technique that a trans xing k-wire across the epiphyseal growth plate, which has never been reported to cause epiphysiodesis [22].…”

Section: Discussionmentioning

confidence: 99%

Closed Reduction of Severely Angulation Rockwood and Wilkins’ Type C Thumb Metacarpal Base Fractures in Children

Qiao

Jiang²

2020

Preprint

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Background: Management of severely angulation Rockwood and Wilkins’ type C(RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of leverage reduction and dual antegrade crossing Kirschner wires (DACK-wires) fixation in these fractures, aiming to assess the results using our technique.Methods: From October 2011 to September 2015, 17 children with severely angulation RW-C thumb metacarpal base fractures were treated at our institute. All patients underwent percutaneous leverage reduction and DACK-wires fixation in an average surgery time of 20 minutes (range 12 ~ 32minutes). The injured arm was immobilized of a thumb-spica cast including the entire first ray for 4-6 weeks, evaluated clinically and radiologically. The Cannon scoring system were used to evaluate the results. Percutaneous leverage and DACK-wires fixation were performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 30 months (range 12-41 months). Results: There were 9 girls and 7 boys with ages ranging from 7.5 to 14.0 years and an average age of 10.8 years. Percutaneous leverage reduction and DACK-wires were successfully used in an average total surgery time of 20 minutes (range 12 ~ 32 minutes). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4~6 weeks). The average angulation (pre-operation; 50.5° (range 40.8°–67.0°) vs post-operation: 5.0° (range 0.0°–7.0°) was significantly different(P<0.05). The clinical results were evaluated by the Cannon scoring system, and there were 15 excellent results and one good result. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from superficial infection which was resolved after removal of k-wires and oral antibiotics. Cosmetic results were described as good and satisfactory by all patients.Conclusion: Our percutaneous leverage technique with DACK-wires fixation can be successfully used to these fractures. This technique is simple to learn and minimally invasive, and the results are excellent.

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Percutaneous Fixation of First Metacarpal Base Fractures Using Locked K-Wires

Cited by 30 publications

References 16 publications

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial

Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Closed Reduction of Severely Angulation Rockwood and Wilkins’ Type C Thumb Metacarpal Base Fractures in Children

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