Results of surgical treatment in metacarpal shaft fractures using low profile mini plates

Aykut, Serkan; Öztürk, Kahraman; Özcan, Çağrı; Demiroğlu, Murat; Gürün, Ahmet Utku; Özden, Erdem

doi:10.5505/tjtes.2015.01651

Cited by 11 publications

(17 citation statements)

References 28 publications

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“…Metacarpal shaft fractures account for the second highest number of metacarpal fractures, following only metacarpal neck fractures. Metacarpal shaft fractures and metacarpal neck fractures occur at a ratio of 1:2 [ 1 ]. Metacarpal shaft fractures commonly occur due to axial loading, torsion, or direct blows.…”

Section: Introductionmentioning

confidence: 99%

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Chiu

Ting

et al. 2021

BMC Musculoskelet Disord

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Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

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Section: Introductionmentioning

confidence: 99%

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Chiu

Ting

et al. 2021

BMC Musculoskelet Disord

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“…Transverse metacarpal shaft fractures are considered particularly unstable because of the small contact area of the fractured site and the exposure to traction force generated by the interosseous muscles [ 4 ]. Cast immobilization for transverse metacarpal shaft fractures can eventually result in fracture displacement and treatment failure because of insufficient force for maintaining fracture reduction [ 6 , 7 ]. Accordingly, most relevant studies and hand surgeons’ recommendations are surgical reduction and metallic implant fixation for transverse metacarpal shaft fractures to optimize treatment results [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

Chiu

Hsu

et al. 2021

BMC Musculoskelet Disord

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Background Metacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure. Objective To evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires. Materials and methods We used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force–displacement data. The Mann–Whitney U test was used to compare between-group differences in maximum fracture force and stiffness. Results The maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p < 0.05; Figure 5a), with the median of the KP&F8 group exceeding that of the KP group by 57.5%. Similarly, stiffness was significantly lower in the KP group (18.14 ± 9.84 N/mm) than in the KP&F8 group (38.25 ± 23.49 N/mm; p < 0.05; Figure 5b), with the median of the KP&F8 group exceeding that of the KP group by 110.9%. Conclusion The incorporation of a figure-of-eight cerclage wire increased the maximum fracture force and stiffness by 57.5 and 110.9%, respectively, compared with those achieved in standard two K-wire fixation. Therefore, hand surgeons are advised to consider the proposed approach to increase fixation strength.

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“…The metacarpal and phalangeal fractures can be further sub-classified as transverse, oblique, spiral, or comminuted based on the fracture geometry. Stepping on hand or ball shock, as examples of direct trauma, mostly causes transverse and comminuted fracture, whereas sprain injuries like falling on the outstretched arm causes spiral and oblique fracture [2].…”

Section: Introductionmentioning

confidence: 99%

“…Most metacarpal and phalangeal fractures are treated conservatively, if closed methods fail to achieve or maintain reduction when there is angulation, rotation or shortness because of the location, surgery could be used [2].…”

Section: Introductionmentioning

confidence: 99%

Biodegradable Plates Versus Titanium Mini-Plates for Fixation of Metacarpal and Phalangeal Fractures

Hassan

Mohamed

Eissa

2020

The Egyptian Journal of Plastic and Reconstructive Surgery

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Background: Metacarpal and phalangeal bones are prone to injury in daily work and life and hand fractures account for about 1.5% of all emergency room visits. Problems associated with those fractures relate to shortening, rotation, and dorsal apex angulation. If closed methods of treatment fail to achieve or maintain reduction, surgery could be used. Oblique and spiral fractures are prone to mal-rotation so operative fixation could be necessary. Commonly used surgical techniques are Kirschner-wire, miniplate, and screw fixations. Biodegradable materials such as Polyglycolic acid (PGA) and Poly-L-lactic acid (PLA) implants have been widely used for hand fracture fixation including pins, rods, screws and plates. Patients and Methods:In this study, we compare the results of fixation of metacarpal fractures by titanium metal plates (group A) with the results of biodegradable plates (group B). This study involved twenty patients who presented with metacarpal and phalangeal fractures who presented to . Surgical procedure was performed under local intravenous or general anaesthesia. We followed cases for 6 months postoperatively.Results: Mean age = 38.9±14.9 and 35.7±13.1 years old for group A and B respectively. 13 patients were males and 7 were female. Operative time in group A was 55±19.4 minutes while in group B, it was 84.5±21.2 minutes. In group A, total range of motion was 234±15.05 degrees while in group B, it was 133±17.02 degrees as measured by goniometer. In group A, time for union was 7.5±1.7 weeks while in group B, unfortunately no union occurred. In group A, one case (10% of cases) was complicated with delayed union and another case of infection (10% of cases), while in group B all cases were complicated with non-union and fracture displacement which forced us to replace with K-wire fixation. Conclusion:In this series of metacarpal and phalangeal fractures treated with titanium or biodegradable plates and screws, titanium plates (group A) showed more favorable outcomes. The stable bony construct achievable by using titanium plates and screws (group A) is the key to good functional results compared with the bad results using biodegradable plates and screws (group B). Further studies are required.Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Results of surgical treatment in metacarpal shaft fractures using low profile mini plates

Cited by 11 publications

References 28 publications

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

Biodegradable Plates Versus Titanium Mini-Plates for Fixation of Metacarpal and Phalangeal Fractures

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