Metacarpal shaft fracture fixation with intramedullary k-wire: Surgical and Clinical outcomes

Abstract Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02575-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yung-Cheng Chiu ◽

Cheng-En Hsu ◽

Tsung-Yu Ho ◽

Yen-Nien Ting ◽

Ming-Tzu Tsai ◽

...

Keyword(s):

Mechanical Strength ◽

Locking Plate ◽

Plate Fixation ◽

Shaft Fracture ◽

Bone Plate ◽

Lateral Side ◽

Lateral Plate ◽

Fracture Force ◽

Shaft Fractures ◽

Metacarpal Shaft

Abstract 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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Bone density correlates with clinical outcomes after ankle fracture fixation

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-018-3017-7 ◽

2018 ◽

Vol 138 (12) ◽

pp. 1653-1657 ◽

Cited By ~ 6

Author(s):

Stephen J. Warner ◽

Matthew R. Garner ◽

Peter D. Fabricant ◽

Dean G. Lorich

Keyword(s):

Bone Density ◽

Clinical Outcomes ◽

Fracture Fixation ◽

Ankle Fracture

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Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation

Foot & Ankle International ◽

10.1177/1071100717732383 ◽

2017 ◽

Vol 39 (1) ◽

pp. 35-45 ◽

Cited By ~ 21

Author(s):

Seung Hun Woo ◽

Su-Young Bae ◽

Hyung-Jin Chung

Keyword(s):

Clinical Outcomes ◽

Fracture Fixation ◽

Ankle Fracture ◽

Linear Regression Analysis ◽

Case Series ◽

Deltoid Ligament ◽

Radiographic Findings ◽

Group 2 ◽

Repair Group

Background: There is no consensus on the optimal treatment or preferred method of operation for the management of acute deltoid ligament injuries during an ankle fracture fixation. This study aimed to analyze the outcomes of repairing the deltoid ligament during the fixation of an ankle fracture compared to conservative management. Methods: We retrospectively evaluated 78 consecutive cases of a ruptured deltoid ligament with an associated ankle fracture between 2001 and 2016. All of the ankle fractures were treated with a plate and screw fixation. Patients in the conservative treatment for ruptured deltoid ligament underwent management from 2001 to 2008 (37 fractures, group 1), while the operative treatment for ruptured deltoid ligament was included from 2009 to 2016 (41 fractures, group 2). The outcome measures included radiographic findings, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scores, visual analog scale scores, and the Foot Function Index. All patients were followed for an average of 17 months. Results: Radiologic findings in both groups were comparable, but the final follow-up of the medial clear space (MCS) was significantly smaller in the group 2 ( P < .01). Clinical outcomes were similar between the two groups ( P > .05). Comparing those who underwent syndesmotic fixation between both groups, group 2 showed a significantly smaller final follow-up MCS, and all clinical outcomes were better in group 2 ( P < .05). Linear regression analysis showed that the final follow-up MCS had a significant influence on clinical outcomes ( P < .05). Conclusion: Although the clinical outcomes were not significantly different between the 2 groups, we obtained a more favorable final follow-up MCS in the deltoid repair group. Particularly when accompanied by a syndesmotic injury, the final follow-up MCS and the clinical outcomes were better in the deltoid repair group. In the case of high-grade unstable fractures of the ankle with syndesmotic instability, a direct repair of the deltoid ligament was adequate for restoring medial stability. Level of Evidence: Level III, retrospective comparative case series.

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Femur Shaft Fracture Fixation in Head-Injured Patients: When Is the Right Time?

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e3181b6bdfc ◽

2010 ◽

Vol 24 (2) ◽

pp. 107-114 ◽

Cited By ~ 42

Author(s):

Michael A Flierl ◽

Jason W Stoneback ◽

Kathryn M Beauchamp ◽

David J Hak ◽

Steven J Morgan ◽

...

Keyword(s):

Fracture Fixation ◽

Shaft Fracture ◽

Femur Shaft Fracture ◽

Head Injured ◽

The Right ◽

Femur Shaft ◽

Injured Patients

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Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation

Journal of the Mechanical Behavior of Biomedical Materials ◽

10.1016/j.jmbbm.2015.11.023 ◽

2016 ◽

Vol 56 ◽

pp. 87-97 ◽

Cited By ~ 8

Author(s):

Saeid Samiezadeh ◽

Zouheir Fawaz ◽

Habiba Bougherara

Keyword(s):

Carbon Fibre ◽

Intramedullary Nail ◽

Fracture Fixation ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Biomechanical Properties

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Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

10.21203/rs.3.rs-628593/v1 ◽

2021 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Xin Tang ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Intramedullary Nail ◽

Shaft Fracture ◽

Tibial Fractures ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Elastic Stable Intramedullary Nail ◽

Open Tibial Fractures ◽

Significant Difference

Abstract IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

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