Osteosynthesis in Long Oblique and Spiral Metacarpal Fractures: Comparison Between Interfragmentary Screws and Plating
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Published:
Oct 10, 2021
Keywords:
Fracture, metacarpal, osteosynthesis, plate, screws
Main Article Content
Abstract
Objective: To compare open reduction and internal fixation with interfragmentary screws and with plates and screws for the treatment of long oblique or spiral metacarpal fractures.
Materials and Methods: A comparative retrospective study was carried out between 2 groups of patients treated surgically. In the first group, 24 patients were treated with interfragmentary screws and in the second group, 17 patients were treated with plate and screw osteosynthesis. A dorsal longitudinal approach was used. Postoperatively, immobilization was performed using a plaster splint; both groups followed rehabilitation with same occupational therapist team. After a minimum follow-up of 12 months, they were evaluated with the DASH score, total active motion (TAM), pulp-to-palm distance, and comparative contralateral dynamometry. A p value < 0.05 was considered significant.
Results: The average followup was 24.5 months (range 12-43 months). There were no statistically significant differences in DASH, TAM, pulp-to-palm distance, and strength. The group treated with plate and screw fixation returned to work earlier, although there were two cases of implant removal, in addition to tendon adherence (tenolysis) in one of them.
Conclusions: The treatment of patients with long oblique or spiral metacarpal fractures with interfragmentary screws or plates and screws showed similar outcomes; the treatment with plateand screws allowed an earlier return to work but had a greater number of complications.
Materials and Methods: A comparative retrospective study was carried out between 2 groups of patients treated surgically. In the first group, 24 patients were treated with interfragmentary screws and in the second group, 17 patients were treated with plate and screw osteosynthesis. A dorsal longitudinal approach was used. Postoperatively, immobilization was performed using a plaster splint; both groups followed rehabilitation with same occupational therapist team. After a minimum follow-up of 12 months, they were evaluated with the DASH score, total active motion (TAM), pulp-to-palm distance, and comparative contralateral dynamometry. A p value < 0.05 was considered significant.
Results: The average followup was 24.5 months (range 12-43 months). There were no statistically significant differences in DASH, TAM, pulp-to-palm distance, and strength. The group treated with plate and screw fixation returned to work earlier, although there were two cases of implant removal, in addition to tendon adherence (tenolysis) in one of them.
Conclusions: The treatment of patients with long oblique or spiral metacarpal fractures with interfragmentary screws or plates and screws showed similar outcomes; the treatment with plateand screws allowed an earlier return to work but had a greater number of complications.
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How to Cite
Ferrando, Ángel, Belluschi, G. F., Andreozzi, R., Perrone, J. M., Sarmiento, H., & Petrucelli, E. (2021). Osteosynthesis in Long Oblique and Spiral Metacarpal Fractures: Comparison Between Interfragmentary Screws and Plating. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 621-628. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1345
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Clinical Research
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References
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fractures: a biomechanical analysis of screw types and techniques. Hand (NY) 2008;3(4):311-5.
https://doi.org/10.1007/s11552-008-9108-0
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https://doi.org/10.1016/j.jhsa.2004.07.016
11. Simonetti L, Boretto J, Galucci G, Sarme A, De Carli P. Fracturas diafisarias de los metacarpianos. Tratamiento con tornillos interfragmentarios. Rev Asoc Arg Ortop Traumatol 2009;74(3):242-8. Disponible en:
https://www.aaot.org.ar/revista/2009/n3/Rev_AsocArgentOrtopTraumatol_242Boretto.pdf
12. Stern PJ. Fractures of the metacarpals and phalanges. En: Green DP, Hotchikss RN, Pederson WC, Wolfe SW (eds.). Green´s operative hand surgery, 5th ed. Philadelphia: Elsevier Churchill Livingstone; 2005, vol. 1, p. 286-94.
13. Tang JB, Blazar PE, Giddins G, Lalonde D, Martínez C, Solomons M. Overview of indications, preferred methods and technical tips for hand fractures from around the world. J Hand Surg Eur 2015;40E(1):88-97.
https://doi.org/10.1177/1753193414561942
14. Prevel CD, Eppley BL, Jackson JR, Moore K, McCarthy M, Sood R, et al. Mini ad micro plating of phalangeal and
metacarpal fractures: a biomechanical study. J Hand Surg Am 1995;20:44-9. https://doi.org/10.1016/s0363-5023(05)80057-7
15. Cordey J, Borgeaud M, Perren SM. Force transfer between the plate and the bone: relative importance of the
bending stiffness of the screws friction between plate and bone. Injury 2000;31(3):21-8. https://doi.org/10.1016/s0020-1383(00)80028-5
16. Ochman S, Doht S, Paletta J, Langer M, Raschke M, Meffert R. Comparison between locking and non-locking
plates for fixation of metacarpal fractures in an animal model. J Hand Surg Am 2010;35:597-603.
https://doi.org/10.1016/j.jhsa.2010.01.002
17. Trevisan C, Morganti A, Casiraghi A, Marinoni E. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 2004;124(10):675-80.
https://doi.org/10.1007/s00402-004-0745-7
18. Firoozbakhsh K, Moneim M, Howey T, Castaneda E, Pirela-Cruz M. Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques. J Hand Surg Am 1993;18(6):1059-68.
https://doi.org/10.1016/0363-5023(93)90403-P
500. https://doi.org/10.1016/j.hcl.2013.08.004
2. Basar H, Basar B, Bacsi O, Topkar OM, Erol B, Tetik C. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only. Arch Orthop Trauma Surg 2015;135(4):499-504. https://doi.org/10.1007/s00402-015-2164-3
3. Freeland AE, Geissler WB, Weiss AP. Surgical treatment of common displaced and unstable fractures of the hand. Instr Course Lect 2002;51:185-201. PMID: 12064103
4. Freeland AE, Orbay JL. Open reduction and internal fixation of the tubular bones of the hand. En: Strickland JW,
Graham T. Master techniques in orthopaedic surgery. The Hand. 2nd ed. Philadelphia: Lippincott Williams &
Wilkins; 2016:3-26.
5. Heim U, Pfeiffer KM. Interfragmental compression with lag screws. En: Heim U, Pfeiffer KM (ed.). Internal
fixation of small fractures. Berlin: Springer Verlag; 1988:32-4.
6. Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg 2008;16(10):586-95. https://doi.org/10.5435/00124635-200810000-00004
7. Jeff Justis E. Fracturas luxaciones y lesiones ligamentarias. En: Campbell Cirugía ortopédica, 8a ed. Buenos Aires: Panamericana; 1992:2912-20.
8. Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 2006;22(3):287-95. https://doi.org/10.1016/j.hcl.2006.02.018
9. Liporace FA, Kinchelow T, Gupta S, Kubiak E, McDonnell M. Minifragment screw fixation of oblique metacarpal
fractures: a biomechanical analysis of screw types and techniques. Hand (NY) 2008;3(4):311-5.
https://doi.org/10.1007/s11552-008-9108-0
10. Roth JJ, Auerbach DM. Fixation of hand fractures with bicortical screws. J Hand Surg Am 2005;30(1):151-3.
https://doi.org/10.1016/j.jhsa.2004.07.016
11. Simonetti L, Boretto J, Galucci G, Sarme A, De Carli P. Fracturas diafisarias de los metacarpianos. Tratamiento con tornillos interfragmentarios. Rev Asoc Arg Ortop Traumatol 2009;74(3):242-8. Disponible en:
https://www.aaot.org.ar/revista/2009/n3/Rev_AsocArgentOrtopTraumatol_242Boretto.pdf
12. Stern PJ. Fractures of the metacarpals and phalanges. En: Green DP, Hotchikss RN, Pederson WC, Wolfe SW (eds.). Green´s operative hand surgery, 5th ed. Philadelphia: Elsevier Churchill Livingstone; 2005, vol. 1, p. 286-94.
13. Tang JB, Blazar PE, Giddins G, Lalonde D, Martínez C, Solomons M. Overview of indications, preferred methods and technical tips for hand fractures from around the world. J Hand Surg Eur 2015;40E(1):88-97.
https://doi.org/10.1177/1753193414561942
14. Prevel CD, Eppley BL, Jackson JR, Moore K, McCarthy M, Sood R, et al. Mini ad micro plating of phalangeal and
metacarpal fractures: a biomechanical study. J Hand Surg Am 1995;20:44-9. https://doi.org/10.1016/s0363-5023(05)80057-7
15. Cordey J, Borgeaud M, Perren SM. Force transfer between the plate and the bone: relative importance of the
bending stiffness of the screws friction between plate and bone. Injury 2000;31(3):21-8. https://doi.org/10.1016/s0020-1383(00)80028-5
16. Ochman S, Doht S, Paletta J, Langer M, Raschke M, Meffert R. Comparison between locking and non-locking
plates for fixation of metacarpal fractures in an animal model. J Hand Surg Am 2010;35:597-603.
https://doi.org/10.1016/j.jhsa.2010.01.002
17. Trevisan C, Morganti A, Casiraghi A, Marinoni E. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 2004;124(10):675-80.
https://doi.org/10.1007/s00402-004-0745-7
18. Firoozbakhsh K, Moneim M, Howey T, Castaneda E, Pirela-Cruz M. Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques. J Hand Surg Am 1993;18(6):1059-68.
https://doi.org/10.1016/0363-5023(93)90403-P