Current methods, outcomes and challenges for the treatment of hand fractures

Boeckstyns, Michel E. H.

doi:10.1177/1753193420928820

Cited by 13 publications

(7 citation statements)

References 66 publications

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“…It must be pointed out that hand surgeons worldwide use percutaneous pinning much more frequently than plating metacarpal fractures, and many surgeons think plating is unnecessary and may lead to complications inherent to the use of plating (Boeckstyns, 2020; Tang 2015; Tang et al., 2015; Xing and Tang, 2014). In our study, we did not compare IHCS with pinning, and it is possible that pinning will have fewer complication and same or better recovery of function than IHCS.…”

Section: Discussionmentioning

confidence: 99%

“…Our study does not provide any data for comparison of IHCS with pinning, and obviously does not suggest this is superior to the commonly used pinning. Many surgeons feel pinning is safe and sufficient for the metacarpal fracture, and pinning is even simpler than IHCS (Boeckstyns, 2020; Xing and Tang, 2014). Clearly, pinning does not have problems of creating cartilage defects in joints, and plate removal seen in IHCS or plating.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

Kibar

Cavit

Örs

2021

J Hand Surg Eur Vol

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We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18–61) in the IHCS group and 32 years (range 17–68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures. Level of evidence: I

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

Kibar

Cavit

Örs

2021

J Hand Surg Eur Vol

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“…Treatment in cases with dislocation involves stable internal fixation, mostly through a dorsal approach. Screws and Kirschner wires (K-wires) are generally preferred due to the risk of complication with plates (Boeckstyns, 2020). The primary long-term complication of these fractures is stiffness.…”

Section: Metacarpal Head Fracturesmentioning

confidence: 99%

“…In general, acceptable angulation for the index and middle fingers is less than 15°, with the ring in the range of 20° to 40°, and the small finger up to 60°. In these instances, patients must be informed that although function is acceptable, the cosmetic loss of the ‘knuckle’ will likely occur, and there is potential for dorsal metacarpal neck and palmar head prominence (Boeckstyns, 2020). Additional indications for operative fixation include malrotation or unacceptable alignment after closed reduction.…”

Section: Non-thumb Metacarpal Fracturesmentioning

confidence: 99%

Metacarpal fractures

Lambi,

Rowland,

Brady

et al. 2023

J Hand Surg Eur Vol

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Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.

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“…Detailed quantification of the preoperative joint situation and the use of 3D patient-specific guides have shown to be helpful in various situations such as treatment of malunited fractures and complex situations in various joints [5,6,[14][15][16][17][18]. When involving the articular surface, residual intra-articular deformity is not well tolerated [19,20] and accurate reconstruction of joint congruency is of upmost importance. Since studies using PSI for intraarticular correction of postoperative malformation are lacking, comparison and discussion of results is not possible.…”

Section: Outcome Improved In Most Casesmentioning

confidence: 99%

3D planning and patient specific instrumentation for intraarticular corrective osteotomy of trapeziometacarpal-, metacarpal and finger joints

Kabelitz

Furrer²,

Hodel³

et al. 2022

BMC Musculoskelet Disord

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Background Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints. Methods Computer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)). Results Ten patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98). Conclusion The use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.

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Current methods, outcomes and challenges for the treatment of hand fractures

Cited by 13 publications

References 66 publications

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures

Metacarpal fractures

3D planning and patient specific instrumentation for intraarticular corrective osteotomy of trapeziometacarpal-, metacarpal and finger joints

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