Comparison of 2-Dimensional and 3-Dimensional Metacarpal Fracture Plating Constructs Under Cyclic Loading

Tannenbaum, Eric; Burns, Geoffrey T.; Oak, Nikhil R.; Lawton, Jeffrey N.

doi:10.1016/j.jhsa.2017.01.003

Cited by 13 publications

(20 citation statements)

References 18 publications

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“…Furthermore, the maximum fracture force and stiffness values obtained by Barr et al were slightly lower than those obtained in the current study; we inferred that this might be caused by the different brand of the bone plates and the different number of fixation screws used. Additionally, Tannenbaum et al [ 27 ] similarly used locking plates for fixating metacarpal shaft fractures. The fracture force and stiffness values they obtained were 190 + 17 N and 11.2 + 1.0 N/mm, respectively.…”

Section: Discussionmentioning

confidence: 99%

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Chiu

Hsu

et al. 2021

J Orthop Surg Res

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Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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Section: Discussionmentioning

confidence: 99%

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Chiu

Hsu

et al. 2021

J Orthop Surg Res

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“…Some of these rotation abnormalities may be due to the use of a single KW, with no locking device to fix the fracture. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures

Lv¹,

Nie²,

Guo³

et al. 2021

Medicine

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The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures. We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups. The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable ( P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ± 7.23 vs 25.64 ± 6.29; 7.13 ± 2.38 vs 5.26 ± 1.71; 67.43 ± 22.01 vs 52.57 ± 17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score ( P < .05). Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.

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“…Tannenbaum and colleagues attempted to address this issue by examining possible differences in construct stability regarding smaller 3-dimensional and larger 2-dimensional plates for fixation of metacarpal fractures. They propose that lowerprofile 3-dimensional plates provide greater stability and reduce complications such as soft tissue stripping, plate prominence, and tendonitis (Tannenbaum et al, 2017). One study has evaluated total length, proximal metaphyseal width, distal metaphyseal width, isthmus width and medullary canal width in 50 radiographic cadaver hands, in efforts to provide preliminary data for locked metacarpal nail design (Boonyasirikool and Niempoog, 2014).…”

Section: Introductionmentioning

confidence: 99%

Morphometric analysis of the second through fifth metacarpal through posteroanterior X‐Rays

et al. 2019

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Over the past 10 years, metacarpal fractures have had an annual incidence of 13.6 per 10,000 individuals. Literature has not reviewed anatomical variations through radiographic imaging, which may play a role in reducing postoperative complications. The purpose of this study was to use radiographic imaging to provide a detailed anatomy of the second through fifth metacarpals. This retrospective study measured length, neck width, narrowest body width, and narrowest medullary canal width of the second through fifth metacarpals through the use of posteroanterior X‐rays. Patients who were ≥18 years and received hand radiographs from January 2015 to July 2019 were included in this study. Those with acute injury or fracture of the metacarpal were excluded. Five hundred and seventy‐two metacarpals were included in this study, with 143 metacarpals measured each for the second through fifth metacarpal. The second metacarpal had the largest measured length, neck width, and narrowest body width at 68.72, 12.34, and 8.74 mm, respectively. The fifth metacarpal had the greatest average medullary canal width at 4.15 mm. This is the largest study in literature to comprehensively examine the anatomical variation of the second through fifth metacarpals. The second metacarpal had greatest dimensions except for canal width, which was the fifth metacarpal. Men almost consistently had greater metacarpal size when compared to women, and age was associated with second and third metacarpal canal width. The increased knowledge of metacarpal anatomy may potentially lay the foundation of further improvement of metacarpal implants and potentially reduce postoperative complications. Clin. Anat., 33:1014–1018, 2020. © 2019 Wiley Periodicals, Inc.

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Comparison of 2-Dimensional and 3-Dimensional Metacarpal Fracture Plating Constructs Under Cyclic Loading

Cited by 13 publications

References 18 publications

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures

Morphometric analysis of the second through fifth metacarpal through posteroanterior X‐Rays

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