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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2017, Number 2

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Acta Ortop Mex 2017; 31 (2)

Minimal invasive osteosynthesis with cannulated screws in metacarpal fractures

Romo-Rodríguez R, Arroyo-Berezowsky C

Language: Spanish
References: 24
Page: 75-81
PDF size: 381.94 Kb.


ABSTRACT

Metacarpal fractures comprise 18 to 44% of hand fractures. Fractures from the second to the fifth metacarpals are 88% of the metacarpal fractures and fractures of the fifth metacarpals are the most common. Fractures of the neck of the fifth metacarpal are about 20% of all the hand fractures. Most of these fractures can be treated conservatively with good functional results. However, for those neck and shaft unstable fractures that need surgical treatment, there is no gold standard for osteosynthesis. Recently, there have been reports of minimally invasive osteosynthesis using headless retrograde intramedullary cannulated screws with good functional results. Material and methods: We report our short term experience treating nine fifth metacarpal neck fractures, one fourth metacarpal neck fracture and a transverse fifth metacarpal shaft fracture that did not fulfill criteria for conservative treatment. We treated them with minimally invasive osteosynthesis using retrograde intramedullary headless cannulated screws. Results: All patients showed radiographic healing and had full range of motion of the metacarpophalangeal joint at one month follow up except for one patient who suffered a dorsal mutilating hand injury along with a fifth metacarpal neck fracture. One patient had osteoporotic bone and we could not control height loss with screws, so we had to use k-wires. Conclusion: Minimally invasive osteosynthesis with cannulated headless retrograde screws is a good option to treat neck and transverse diaphyseal fractures of the metacarpals. It confers a stable construct that allows early range of motion and return to activities.


REFERENCES

  1. Kollitz KM, Hammert WC, Vedder NB, Huang JI: Metacarpal fractures: treatment and complications. Hand (N Y). 2014; 9(1): 16-23.

  2. de Góes-Ribeiro A, Gonçalez DH, Filho JM, da Fonseca GM, Costa AC, Chakkour I: What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study. Rev Bras Ortop. 2016; 51(2): 150-6.

  3. Dunn JC, Kusnezov N, Orr JD, Pallis M, Mitchell JS: The boxer’s fracture: splint immobilization is not necessary. Orthopedics. 2016; 39(3): 188-92.

  4. Pace GI, Gendelberg D, Taylor KF: The effect of closed reduction of small finger metacarpal neck fractures on the ultimate angular deformity. J Hand Surg Am. 2015; 40(8): 1582-5.

  5. van Aaken J, Fusetti C, Luchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, et al: Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Arch Orthop Trauma Surg. 2016; 136(1): 135-42.

  6. Eglseder WA Jr., Juliano PJ, Roure R: Fractures of the fourth metacarpal. J Orthop Trauma. 1997; 11(6): 441-5.

  7. Bernstein ML, Chung KC: Hand fractures and their management: an international view. Injury. 2006; 37(11): 1043-8.

  8. Theeuwen GA, Lemmens JA, van Niekerk JL: Conservative treatment of boxer’s fracture: a retrospective analysis. Injury. 1991; 22(5): 394-6.

  9. Sahu A, Gujral SS, Batra S, Mills SP, Srinivasan MS: The current practice of the management of little finger metacarpal fractures--a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg. 2012; 17(1): 55-63.

  10. Ozturk I, Erturer E, Sahin F, Seckin F, Toker S, Uzun M, et al: Effects of fusion angle on functional results following non-operative treatment for fracture of the neck of the fifth metacarpal. Injury. 2008; 39(12): 1464-6.

  11. Ruchelsman DE, Puri S, Feinberg-Zadek N, Leibman MI, Belsky MR: Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am. 2014; 39(12): 2390-5.

  12. Boulton CL, Salzler M, Mudgal CS: Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am. 2010; 35(8): 1260-3.

  13. del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L: Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am. 2015; 40(4): 692-700.

  14. Calder JD, O’Leary S, Evans SC: Antegrade intramedullary fixation of displaced fifth metacarpal fractures. Injury. 2000; 31(1): 47-50.

  15. Cepni SK, Aykut S, Bekmezci T, Kilic A: A minimally invasive fixation technique for selected patients with fifth metacarpal neck fracture. Injury. 2016; 47(6): 1270-5.

  16. Zhang X, Huang X, Shao X: Reduction of fifth metacarpal neck fractures with a Kirschner wire. J Hand Surg Am. 2015; 40(6): 1225-30.

  17. Ferreira GP, Pires PR, Portugal AL, Schneiter Hde G: Intra-focal reduction and percutaneous fixation of neck fractures of the fifth metacarpal: description of surgical technique. Rev Bras Ortop. 2014; 49(2): 116-20.

  18. Kim JK, Kim DJ: Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015; 473(5): 1747-54.

  19. Pan YW, Li PC, Zhu J, Li ZZ, Li YC, Zhu Y: Antegrade intramedullary fixation of the neck and subcapital fractures of the fifth metacarpal. Zhonghua Wai Ke Za Zhi. 2006; 44(24): 1689-92.

  20. Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P: Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? Orthop Traumatol Surg Res. 2010; 96(5): 506-12.

  21. Boussakri H, Elidrissi M, Azarkane M, Bensaad S, Bachiri M, Shimi M, et al: Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases). Pan Afr Med J. 2014; 18: 187.

  22. Yammine K, Harvey A: Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2014; 24(3): 273-8.

  23. ten Berg PW, Mudgal CS, Leibman MI, Belsky MR, Ruchelsman DE: Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures. J Hand Surg Am. 2013; 38(2): 322-30.e2.

  24. Doarn MC, Nydick JA, Williams BD, Garcia MJ: Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results. Hand (N Y). 2015; 10(2): 314-8.




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