Intra-focal reduction and percutaneous fixation of neck fractures of the fifth metacarpal: description of surgical technique

Ferreira, Gustavo Pacheco Martins; Pires, Paulo Randal; Portugal, André Lopes; Schneiter, Henrique de Gouvêa

doi:10.1016/j.rboe.2014.03.013

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…16 Another concern is the violation of the MCPJ or the extensor mechanism that could jeopardize the final active ROM. This could be overcome by the introduction of different modifications on the intramedullary fixation techniques including antegrade introduction of the nails, 15 intrafocal K-wire fixation, 17 and transverse K-wire technique. 18,19 Moreover, when the intramedullary K-wires fixation was compared with locked miniplating in the fixation of fifth metacarpal neck fractures, the final active ROM was better in the K-wires group.…”

Section: Discussionmentioning

confidence: 99%

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Sadek

2020

Journal of Hand and Microsurgery

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Introduction When dealing with metacarpal neck fractures, the aim of treatment should include clinical and radiological objectives. The aim of this study was to assess the efficacy of flexible stable intramedullary nailing for the management of metacarpal neck fractures. Materials and Methods A total of twenty four patients (22 males and 2 females; mean age: 28.2 ± 7.7 years) with metacarpal neck fractures (second in 7 patients and fifth in 17 patients) whether isolated or associated with other body injuries and managed by percutaneous flexible stable intramedullary nailing were reviewed for a retrospective case series. Personal interviews were conducted together with clinical and radiological assessments. The final results were recorded at the time of personal interviews. Results The mean duration of surgery was 19.3 ± 2.5 minutes. The mean time of radiological union was 5 ± 1.3 weeks. The mean postoperative active range of motion of the metacarpophalangeal joint was 102.4 ± 11 degrees. The mean supination power of the involved hand in comparison to the contralateral side was 97.8 ± 3.4%, whereas the pronation power percentage was 99.2% ± 1.6. The mean power grip percentage to the contralateral side was 96.4 ± 2.9%, whereas the mean percentage of the pinch grip was 96.1 ± 4.2%. The mean postoperative DASH (Disability of Arm, Shoulder, and Hand) score was 0.3 ± 0.5. Conclusion Percutaneous flexible stable intramedullary nailing for the treatment of metacarpal neck fractures has expanded the armamentarium of the orthopaedic surgeons as an easy, cost-effective technique overcoming all possible deformities and allowing early and reliable active rehabilitation. Level of Evidence This is a Type IV, therapeutic retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Sadek

2020

Journal of Hand and Microsurgery

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Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals

Esteban-Feliu

Gallardo-Calero

Lluch-Bergadà

et al. 2019

Hand (New York, N,Y.)

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Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.

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Intra-focal reduction and percutaneous fixation of neck fractures of the fifth metacarpal: description of surgical technique

Cited by 2 publications

References 7 publications

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals

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