Clinical Outcomes of Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures

Ruchelsman, David E.; Puri, Sameer; Feinberg-Zadek, Natanya; Leibman, Matthew I.; Belsky, Mark R.

doi:10.1016/j.jhsa.2014.08.016

Cited by 79 publications

(128 citation statements)

References 33 publications

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“…Ruchelsman et al also reviewed 39 patients with a mean age 28 years treated with an IMHS and reported that all fractures healed uneventfully at 6 weeks with no hardware-related complications. 17 Etiology of the discrepancy between our biomechanical findings and the previously described clinical studies may be due to differences in IMHS purchase in the isthmus of the medullary canal versus the metacarpal neck. Our investigation utilized a 2.4-mm IMHS during biomechanical testing, whereas a 3.0-mm IMHS was used in many of the reported clinical cases.…”

Section: Discussioncontrasting

confidence: 76%

“…Using a cannulated headless screw design and a limited-open extensor-splitting approach, IMHS fixation is less invasive than dorsal plating and may allow for early postoperative joint motion. 3,17 The intramedullary technique also allows for direct visualization of the starting point, which eliminates the need for multiple attempts to achieve the correct starting point. In addition, an IMHS addresses several of the limitations associated with intramedullary fixation of metacarpal fractures performed with smooth k-wires including pin track sepsis, k-wire migration, and need for implant removal after bone healing.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures

Melamed

Hinds

Gottschalk

et al. 2016

Hand (New York, N,Y.)

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Background: Recently, intramedullary headless screw (IMHS) has shown promise as an alternative to dorsal plate fixation of metacarpal fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus plating. We hypothesized that IMHS fixation provides inferior stability to plating. Methods: Metacarpal fracture model with 3-mm of volar gapping in forty-four human cadaveric metacarpals was created. The specimens were divided into 5 groups: Group 1, 1.5-mm non-locking plate; Group 2, 1.5-mm locking plate; Group 3, 2.0-mm non-locking plate; Group 4, 2.0-mm locking plate; and Group 5, 2.4-mm short cannulated IMHS. A 4-point bending model was used to assess load-to failure (LTF) and stiffness. Results: Mean LTF was 364 ± 130 N for 1.5-mm non-locking plates, 218 ± 94 N for 1.5-mm locking plates, 421 ± 86 N for 2.0-mm non-locking plates, 351 ± 71 N for 2.0-mm locking plates, and 75 ± 20 N for IMHS. Mean stiffness was 91 ± 12 N/mm for 1.5-mm non-locking plates, 110 ± 77 N/mm for 1.5-mm locking plates, 94 ± 20 N/mm for 2.0-mm non-locking plates, 135 ± 16 N/mm for 2.0-mm locking plates, and 55 ± 15 N/mm for IMHS. IMHS demonstrated significantly lower LTF and stiffness than plates. Conclusions: IMHS fixation of unstable metacarpal shaft fractures offers less stability compared to plating when loaded in bending. The LTF and stiffness of IMHS versus plating of metacarpal shaft fractures has not been previously quantified. Our results reveal that IMHS fixation is less favorable biomechanically and should be carefully chosen in regards to fracture stability.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures

Melamed

Hinds

Gottschalk

et al. 2016

Hand (New York, N,Y.)

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“…Our clinical and functional results are similar to those found in several series published in recent years, showing satisfactory results with this type of treatment. [5][6][7]18,19 The surgical treatment of the metacarpal has been very effective, with results close to 100% mobility.…”

Section: Discussionmentioning

confidence: 99%

“…Internal fixation involves soft tissue dissection, which consequently causes scar tissue to appear on the osteosynthesis plate and on the focus of the fracture, facilitating the tenodesis effect. 4 To achieve adequate fixation of the fracture, and following the experience of other authors [5][6][7] we use retrograde intramedullary cannulated screws in the treatment of fractures of the metacarpals and of the proximal and middle phalanxes. This technique provides rigid fixation and compression of the focus, with minimal soft tissue involvement.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Osteosynthesis with Headless Cannulated Screws in the Treatment of Metacarpal and Proximal and Middle Phalanxes Fractures of the Hand

Casal

Vegas

Díez

et al. 2018

Rev Iberoam Cir Mano

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Introduction There is a high incidence of hand fractures, and a high percentage of them require surgical treatment. The functional result depends, to a large extent, on the technique used. The use of retrograde intramedullary screws allows for early mobilization and minimal dissection of soft tissues. The objective of the present study is to analyze the clinical results and complications with this type of osteosynthesis. Methods A total of 96 fractures in 81 patients were analyzed. There were 62 metacarpal fractures, 60% of which involved the 5th finger, 29% involved the 4th, 5% involved the 3rd, and 6% involved the 2nd finger. There were 34 fractures of the phalanxes, 27 of which (79.5%) involved the proximal phalanx, and 20.5% involved the middle phalanx. The range of active mobility, the time spent at work, and intraoperative complications were assessed. Results The average active mobility obtained was 260° (230–270°). Patients resumed their normal activity within an average time of 5 weeks (between 3 and 32 weeks). There was a 6% rate of intraoperative complications and a 13% rate of postoperative complications in the metacarpals, and an 8% rate of intraoperative complications and 11% of postoperative complications in the phalanxes. Conclusion The use of cannulated screws is a safe and effective option for the treatment of different types of fractures, obtaining a good range of mobility, early reintegration, and with an acceptable number of complications.

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“…7 La utilización de tornillos canulados sin cabeza introducidos de manera retrógrada, está indicado en determinados tipos de fracturas de metacarpianos y falanges y presentan ventajas en relación a los otros tipos de osteosíntesis. [8][9][10][11][12][13] Los tornillos son introducidos percutáneamente, permitiéndonos una fijación estable con una cirugía mínimamente invasiva. Ellos se introducen a través de una superficie articular y debido a su ausencia de cabeza, permiten que sean enterrados en el hueso subcondral sin interferir en el movimiento articular.…”

Section: Introductionunclassified

Use of Intramedullary Cannulated Headless Screws in the Treatment of Hand Fractures - An Anatomical Study on Long Fingers

Vegas

Díez

Núñez

et al. 2017

Rev Iberoam Cir Mano

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Utilización de los tornillos canulados sin cabeza intramedulares en el tratamiento de las fracturas de la mano -estudio anatomico en los dedos largos AbstractObjective To quantify the cartilaginous and tendinous lesions produced upon percutaneous introduction of intramedullary cannulated screws as osteosynthesis material in metacarpal and phalangeal fractures. Materials and Methods Seven anatomical models and one non-replanted hand were used. The measurements of 30 metacarpals and proximal and middle phalanges were taken. Cannulated screws with complete and partial threads were placed percutaneously through the metacarpal head and the proximal and middle phalanges, reproducing the actions performed in the clinic. The following measurements were performed: A) Percentage of the damaged cartilaginous area and its location. B) Damage to the extensor apparatus and its distance to the bone insertion point. C) Bone marrow size. Results (A) The percentages of the damaged areas in the metacarpals, proximal and middle phalanges were 5.7%, 13.35% and 9.62%, respectively. (B) The damage to the extensor apparatus was less than 3 mm with a 4-mm distance to the bone insertion point and (C) We have obtained the measurements of the intramedullary bone and from them, we calculated the width of the most appropriate screw. Conclusion In conclusion, the use of retrograde and percutaneous cannulated screws is a reliable technique with regard to the associated morbidity, and we present an approximation regarding the most appropriate screw for each location. ResumenObjetivo El objetivo de este estudio es cuantificar las lesiones cartilaginosas y tendinosas que se producen al introducir tornillos canulados intramedulares percutá-neos como material de osteosíntesis en fracturas de metacarpianos y falanges.

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Clinical Outcomes of Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures

Cited by 79 publications

References 33 publications

Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures

Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures

Percutaneous Osteosynthesis with Headless Cannulated Screws in the Treatment of Metacarpal and Proximal and Middle Phalanxes Fractures of the Hand

Use of Intramedullary Cannulated Headless Screws in the Treatment of Hand Fractures - An Anatomical Study on Long Fingers

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