Intramedullary Compression Screw Fixation of Proximal Phalangeal Fractures: A Systematic Literature Review

Hand ◽  
2020 ◽  
pp. 155894472092850
Author(s):  
Brahman S. Sivakumar ◽  
Vincent V. G. An ◽  
David J. Graham ◽  
James Ledgard ◽  
Richard D. Lawson ◽  
...  
Keyword(s):  
English Language ◽  
Screw Fixation ◽  
Adhesion Formation ◽  
Major Complication ◽  
Original Data ◽  
Active Motion ◽  
Early Motion ◽  
Total Active Motion ◽  
Phalangeal Fractures ◽  
Intramedullary Screw

Proximal phalangeal fractures have traditionally been fixed via either Kirschner wires or dorsal plating. Concerns regarding lack of compression and potential for infection with wire fixation, and adhesion formation and stiffness with plating, have lead to alternative fixation methods, such as intramedullary screw fixation. However, the literature regarding this modality is limited. Methods: A systematic review was performed to review the literature regarding intramedullary screw fixation for proximal phalangeal fractures. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. 4 studies were eligible for inclusion, with a further 3 studies assessing proximal and middle phalanges analysed separately. Total active motion was greater than 240° in all proximal phalangeal studies; mean post-operative DASH was 3.62. 6% of patients sustained a major complication. Intramedullary screw fixation of proximal phalangeal fractures is safe, providing stable fixation to allow early motion.

Retrograde Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472098807
Author(s):  
Genoveffa R. Morway ◽  
Taylor Rider ◽  
Christopher M. Jones
Keyword(s):  
Screw Fixation ◽  
Kirschner Wire ◽  
Inclusion Criteria ◽  
Kirschner Wires ◽  
Active Motion ◽  
Metacarpal Fractures ◽  
Kirschner Wire Fixation ◽  
Load To Failure ◽  
Total Active Motion ◽  
Intramedullary Screw

Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. A comprehensive literature search was performed using electronic databases for both clinical and biomechanical studies in relation to RIS fixation published from 2000 to 2020. A total of 19 studies (13 clinical and 6 biomechanical) met the inclusion criteria. The clinical studies examined 603 metacarpal fractures and demonstrated adequate functional outcomes in terms of grip strength, total active motion, and time to return to work. The biomechanical studies examined 80 metacarpal fractures, finding that load to failure in RISs was often equal to or higher than Kirschner wires but less than plate and screws. The complication rate in reviewed studies was 2.8%, with the most prevalent complications being stiffness and extension lag. RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality.

scholarly journals The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Michele Abate ◽  
Cosima Schiavone ◽  
Vincenzo Salini
Keyword(s):  
Hyaluronic Acid ◽  
English Language ◽  
Current Knowledge ◽  
Experimental Studies ◽  
Tendon Repair ◽  
Active Motion ◽  
Tissue Healing ◽  
Tendon Surgery ◽  
Total Active Motion ◽  
And Function

Viscosupplementation with hyaluronic acid is safe and effective in the management of osteoarthritis, but its use in the treatment of tendon disorders has received less attention. The aim of this review is to summarize the current knowledge on this topic, evaluating experimental and clinical trials. A search of English-language articles was performed using the key search terms “hyaluronic acid” or “viscosupplementation” combined with “tendon,” “tendinopathy,“ “adhesions,“ or “gliding,“ independently. In quite all the experimental studies, performed after surgical procedures for tendon injuries or in the treatment of chronic tendinopathies, using different hyaluronic acid compounds, positive results (reduced formation of scars and granulation tissue after tendon repair, less adhesions and gliding resistance, and improved tissue healing) were observed. In a limited number of cases, hyaluronic acid has been employed in clinical practice. After flexor tendon surgery, a greater total active motion and fingers function, with an earlier return to work and daily activities, were observed. Similarly, in patients suffering from elbow, patellar, and shoulder tendons disorders, pain was reduced, and function improved. The positive effect of hyaluronic acid can be attributed to the anti-inflammatory activity, enhanced cell proliferation, and collagen deposition, besides the lubricating action on the sliding surface of the tendon.

The Stockport Serpentine Spring System for the Treatment of Displaced Comminuted Intra-Articular Phalangeal Fractures

1990 ◽  
Vol 15 (3) ◽  
pp. 303-311
Author(s):  
N. R. M. FAHMY
Keyword(s):  
Active Motion ◽  
Fracture Dislocations ◽  
Total Active Motion ◽  
Spring System ◽  
Phalangeal Fractures ◽  
New System

A new system has been designed to treat displaced comminuted intra-articular phalangeal fractures and 20 such fracture-dislocations were treated by it. Nineteen of the patients were satisfied at an average follow-up period of 13.6 months, with a mean total active motion of 226°. The results are rewarding considering the gravity of the injuries.

Cost Comparison of Kirschner Wire Versus Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Hand ◽  
2021 ◽  
pp. 155894472110306
Author(s):  
Christopher F. Brewer ◽  
Quillian Young-Sing ◽  
Adam Sierakowski
Keyword(s):  
Health Care ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Complication Rates ◽  
Hand Fractures ◽  
Significant Difference ◽  
Wire Fixation ◽  
Phalangeal Fractures ◽  
Intramedullary Screw

Background Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P = .05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs.

Lessons Learned from the Management of Complex Intra-Articular Fractures at the Base of the Middle Phalanges of Fingers

2003 ◽  
Vol 28 (6) ◽  
pp. 559-565 ◽  
Author(s):  
S. MAJUMDER ◽  
F. PECK ◽  
J. S. WATSON ◽  
V. C. LEES
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Lessons Learned ◽  
Active Motion ◽  
System A ◽  
Articular Fractures ◽  
Active Range Of Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Traction System ◽  
Phalangeal Fractures

The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7–28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74° (range, 0–100°). The mean total active motion of the injured digit was 196° (range, 40–275°). Refinements in the regime are suggested as a result of this investigation.

INTRAMEDULLARY FIXATION OF PROXIMAL PHALANGEAL FRACTURES THROUGH A VOLAR EXTRA-TENDON SHEATH APPROACH

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 141-147 ◽  
Author(s):  
Eichi Itadera ◽  
Yasuhiro Oikawa ◽  
Masataka Shibayama ◽  
Tomoko Kobayashi ◽  
Hideshige Moriya
Keyword(s):  
Kirschner Wire ◽  
Tendon Sheath ◽  
Intramedullary Fixation ◽  
Active Motion ◽  
Shaft Fractures ◽  
Total Active Motion ◽  
Closed Fractures ◽  
Phalangeal Fractures ◽  
Palmar Aspect

We present an operative technique and the results of intramedullary fixation of proximal phalangeal shaft fractures through a volar extra-tendon sheath approach. A J-shaped nail, which is a curved Kirschner wire sharply bent at the proximal end, was inserted from the palmar aspect of the proximal phalangeal base. Six fingers of the six patients (all male) were treated with this method. The mean age of the patients was 51 years (range, 20–69 years). There were four open and two closed fractures. All fingers attained successful fracture union and one of them had correction loss. No patient complained of pain at the final follow-up, and the average of total active motion was 223° (190° – 255°). This method may be an alternative for treatments of the proximal phalangeal shaft fractures because of its less invasive nature, although it does not offer anatomical reduction.

A lactoferrin-derived peptide (PXL01) for the reduction of adhesion formation in flexor tendon surgery: an experimental study in rabbits

2011 ◽  
Vol 36 (8) ◽  
pp. 656-662 ◽  
Author(s):  
M. Wiig ◽  
K. Olmarker ◽  
J. Håkansson ◽  
L. Ekström ◽  
E. Nilsson ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Sodium Hyaluronate ◽  
Tendon Healing ◽  
Negative Effects ◽  
Active Motion ◽  
Load To Failure ◽  
Tendon Surgery ◽  
Total Active Motion

Injuries to flexor tendons can lead to loss of finger function after healing due to adhesion formation. The aim of this study was to assess the efficacy and safety of the new peptide, PXL01, in the prevention of peritendinous adhesions. The effect of a single intraoperative administration of PXL01 in sodium hyaluronate on mobility of the affected digit after surgery was assessed in a rabbit model by measuring total active motion, metatarsophalangeal–claw distance and resistance to bending the digits. Load-to-failure testing was done in the same specimens to assess tendon healing. The results demonstrated that a single application of PXL01 in sodium hyaluronate significantly improved mobility of the treated digits compared with the digits in which the same surgery was carried out but no treatment was provided. No negative effects on tendon healing were observed in connection with the treatment.

Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals

Hand ◽  
2019 ◽  
pp. 155894471987314
Author(s):  
Ignacio Esteban-Feliu ◽  
Irene Gallardo-Calero ◽  
Sergi Barrera-Ochoa ◽  
Alex Lluch-Bergadà ◽  
Sergi Alabau-Rodriguez ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Return To Work ◽  
Grip Strength ◽  
Kirschner Wire ◽  
Rank Test ◽  
Active Motion ◽  
Articular Fractures ◽  
Total Active Motion ◽  
Phalangeal Fractures ◽  
Mean Time

Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.

scholarly journals Functional Outcome Following Hand and Wrist Level Replantation: A Retrospective Review

2020 ◽  
pp. 1-5
Author(s):  
Rahul K. Patil ◽  
Rahul K. Patil ◽  
Venkata Nageshwara Reddy Komma ◽  
Emad Salah Ibrahim ◽  
Abdullah Al Harthi ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Primary Repair ◽  
Distal Forearm ◽  
Level Of Evidence ◽  
Active Motion ◽  
Early Motion ◽  
Sensory Recovery ◽  
Total Active Motion ◽  
Industrial Injuries

Objective: Amputations of fingers and significant parts of upper limbs are common following industrial injuries. This study was aimed at assessing the functional outcome in patients with hand replantation following amputation at the level of distal forearm or wrist. Methods: Patients presenting with amputation at the level of wrist and forearm between Jan 2015 and December 1018, with adequate follow up were included. The function in terms of total active motion at the fingers and wrist, sensory recovery, and patient satisfaction and DASH scores at the final follow up were noted. Results: Four cases of replantation at the level of wrist and one replantation at distal forearm level were included in the study. A total of 3 patients were excluded for various reasons. The average follow-up period was 38 months. The average total active motion of fingers achieved was 212○ . All patients recovered protective sensations. Conclusion: Replantation of amputated major upper limb parts restores useful function and should be attempted. Minimizing ischaemia time, secure fixation, primary repair of structures and early motion are determinants of reasonable functional outcome. Level of evidence: IV.

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