Corrective osteotomy for malunited metacarpal fractures: long-term results of a novel technique

Abstract

Symptomatic malunited metacarpal fractures can significantly affect hand function. We retrospectively reviewed the results of our technique of corrective osteotomy in 14 malunited metacarpal fractures (12 patients) with an average age of 30 years (range 18-49) from January 2005 to December 2011. The dominant hand was involved in nine patients and all except one were male. The malunited metacarpals demonstrated mean dorsal apex angulation of 43° (range 33°-72°) with apparent metacarpal shortening. All except three cases had rotational deformity. All patients underwent surgical correction of the deformity using our described technique of closing wedge osteotomy using temporary intramedullary K-wire and plate fixation. At a mean follow-up of 46 months (range 12-78), the DASH scores improved significantly (p < 0.001). All our patients scored 'excellent' according to the Büchler criteria and at final follow-up had returned to pre-injury work and sports activities. Our technique is safe, easily performed and can be adapted to correct a range of deformities. Level of evidence: Level IV.

Minimally Invasive Corrective Osteotomy (MICO) of the Hand a Novel Technique

“…While certain rigid fixation methods, such as the use of plates, may enable early ROM, this approach demands a high level of technical expertise and entails soft tissue dissection. In addition, hardware removal and tenolysis are frequently required through a subsequent surgical procedure [ 14 , 15 ].…”

Corrective Fifth Metacarpal Neck Osteotomy and Intramedullary Screw Fixation Technique: Technique and Case Report

“…This allows less destruction of the periosteum and less surgical time. Another advantage is the lower scar adhesion of the extensor mechanism and less irritability of the implant, observed in the use of osteosynthesis with plate and screws 1–4,6–8…”

“…Corrective osteotomies of the metacarpals have been indicated very cautiously in the literature. 5,6 The indications to the procedure are the angular deviation of the finger, volar prominence of the head, and pseudoclawing. 5,6 In this case report, the patient also had low metacarpophalangeal mobility and reduced grip strength.…”

“…Another advantage is the lower scar adhesion of the extensor mechanism and less irritability of the implant, observed in the use of osteosynthesis with plate and screws. [1][2][3][4][6][7][8] The disadvantage is the potential risk of rotational deviation by the screw, which can be reduced with the use of buddy-tape between the fourth and fifth fingers, as long as there is no residual rotational deformity after osteotomy. [7][8][9] Recently, biomechanical studies of intramedullary screws for fractures of the metacarpal shaft showed that the plate and screws are more stable than intramedullary screws, but there is still no clinical relevance, allowing their use.…”