Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed <scp>K</scp>‐Wires and Plate‐Screw Constructs

Curtis, Benjamin D; Fajolu, Olukemi; Ruff, Michael E.; Litsky, Alan S.

doi:10.1111/os.12195

Cited by 49 publications

(44 citation statements)

References 33 publications

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“…However, no existent in vitro biomechanical test is able to reflect actual amounts of physiological loading. In addition to the cantilever bending test, previous studies have adopted tests including the three-point bending test [ 17 ], modified three-point bending test [ 13 , 21 , 22 ], four-point bending test [ 16 , 18 ], and torsional test [ 12 , 23 ]. We employed the cantilever bending test instead of a bending test mainly because the aim of the study was to explore fixation approaches for metacarpal neck fracture not metacarpal shaft fracture.…”

Section: Discussionmentioning

confidence: 99%

“…We employed the cantilever bending test instead of a bending test mainly because the aim of the study was to explore fixation approaches for metacarpal neck fracture not metacarpal shaft fracture. Previously, the maximum fracture force and stiffness were common indexes for scholars to determine fixation strength [ 12 , 14 , 16 , 17 , 21 , 23 ]. In this study, however, the strength was assessed by evaluating the stiffness alone.…”

Section: Discussionmentioning

confidence: 99%

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New fixation approach for transverse metacarpal neck fracture: a biomechanical study

et al. 2018

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BackgroundFifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates.MethodsWe used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types.ResultsThe fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm).ConclusionThe fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

et al. 2018

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“…20 Biomechanically, the fixation strength of intramedullary devices and multiple K-wire fixation are comparable. 21 Additional benefits to this technique include early mobilization (typically within 5 days) with subsequent rapid recovery of motion and function.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

2016

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BackgroundThere is a lack of consensus on optimal treatment methods for operative fixation of metacarpal fractures. 1 Classic treatment options include plate and screw fixation or percutaneous fixation with Kirschner wires (K-wires). 1,2 For subcapital fractures or those fractures involving the metacarpal neck, the lack of distal purchase can preclude plate and screw fixation. Short oblique, transverse, comminuted, or multiple metacarpal shaft fractures typically require more rigid fixation with lag screws or plate and screw constructions. Plate and screw fixation can be associated with considerable metacarpophalangeal stiffness, necessitating secondary implant removal and joint release. While K-wire fixation for metacarpal fractures often results in bony union, it necessitates a period of immobilization and has a complication rate up to 16%. 3,4 Bouquet pinning with intramedullary wires placed in an antegrade manner can often be satisfactory but requires immobilization, future implant removal, and may not always offer secure fixation or rotational control. 5 Periarticular fractures of the upper extremity can be reliably treated with buried intra-articular fixation. 6-14 This series presents the clinical results of a relatively new technique of fixation for metacarpal fractures using retrograde intramedullary headless screws (IMHS) that allows early mobilization with minimal complications. Keywords► metacarpal fracture ► intramedullary fixation ► headless compression screw ► minimally invasive AbstractIntroduction The purpose of this study is to examine the clinical results of retrograde intramedullary headless screw (IMHS) fixation for metacarpal fractures. Methods A retrospective review was performed on 16 patients with 18 metacarpal fractures who underwent IMHS fixation at a single institution. The average age was 32 years. The indications for surgery included rotational malalignment (five patients), multiple metacarpal fractures (five patients), angular deformity (four patients), and shortening greater than 5 mm (two patients). The average length of follow-up was 19.4 weeks (median 10.2 weeks). Results Functional outcome was considered excellent in all patients with total active motion in excess of 240 degrees. Active motion was initiated within 1 week of surgery. No secondary surgeries were performed related to a complication of IMHS fixation. Conclusion IMHS fixation of metacarpal fractures is an efficacious treatment modality for patients with comminution, multiple fractures, malrotation, and those who require rapid mobilization. It obviates the need for immobilization or more extensive plate and screw fixation techniques with excellent clinical results.

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“…Despite the advantages, a strong consensus remains between investigators who conclude plate-screw fixation provides the most definitive type of stabilisation in metacarpal fractures in comparison to all other methods including intramedullary nailing 23 - 25 . This appears to be in concordance with findings by Curtis et al who performed a biomechanical comparative analysis between the intramedullary nail, crossed K-wire and plate screw constructs using composite bones 25 . Their data demonstrated that the average load to failure was significantly greater in plate-screw fixation compared to the other two techniques.…”

Section: Discussionmentioning

confidence: 99%

Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-Six Fractures

Ghazala

Choudhry

Rajeev

2018

MOJ

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Introduction: Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period.Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united.Results: The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases.Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.

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Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed K‐Wires and Plate‐Screw Constructs

Cited by 49 publications

References 33 publications

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws

Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-Six Fractures

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