A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

Abstract

Background We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique. Methods We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph. Results The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation. Conclusions The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

“…In comparison to existing biomechanical data by Oh et al we could demonstrate higher peak loads for all tested devices [ 20 ]. This may be due to the effect of a more stable plate and larger diameter intramedullary compression screws with a different design.…”

Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study

“…(2018) reported similar peak load results to those in our study after intramedullary headless screw fixation of metacarpal neck fractures in a dorsal apex cantilever bending human cadaver model. In contrast, Oh et al. (2019) reported higher peak loads between 119 N and 212 N for intramedullary screw fixation of midshaft transverse osteotomies in a 3-point bending test protocol.…”

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

“…Compared with other fixation techniques, plate fixation tends to offer higher stability when loaded in bending (Melamed et al, 2016; Oh et al, 2019). It is still controversial whether K-wire fixation offers higher stability when loaded in bending (Beutel et al, 2018; Oh et al, 2019). However, plate-fixation and K-wire fixation do not compromise the articular surface.…”