RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0040-1714229
Osteosynthesis of Fractures of the Metacarpal Neck with Self-Compressing Screw - Preliminary Analysis of 21 Cases[*]
Artikel in mehreren Sprachen: português | English![](https://www.thieme-connect.de/media/10.1055-s-00042410/202102/lookinside/thumbnails/10-1055-s-0040-1714229_2000012_en-1.jpg)
Abstract
Objective The present study aims to analyze the clinical results of the surgical treatment of metacarpal neck fractures with retrograde intramedullary fixation using cannulated headless screws (Herbert type).
Methods Retrospective study of 21 closed fractures deviated from the metacarpal neck in 21 patients operated between April 2015 and November 2018.
Results The sample included 19 men and 2 women. The mechanisms that caused the trauma were punching, falling to the ground and motor vehicle accident (n = 14, 5 and 2). The affected metacarpals were the 5th, 3rd, and 2nd (n = 19, 1 and 1). Surgical indications were neck-shaft diaphysis of the metacarpal > 30° for the 2nd and 3rd metacarpals and > 40° for the 5th metacarpal, shortening ≥ 5mm, rotational deviation, and the desire of the patient not to use plaster cast. In the immediate postoperative period, patients remained without immobilization and were instructed to mobilize their fingers according to tolerance. All patients had total active mobility > 240° and returned to their former occupations. All fractures consolidated and there were no reinterventions.
Discussion The great advantages of the headless screw technique are its low morbidity, sufficient stability to avoid external immobilization, and reproducibility at low cost.
Conclusion This is an easy, fast technique that has excellent results for the surgical treatment of displaced fractures of the neck of the metacarpals.
* Work developed at the Hand Surgery Group, Orthopedics and Traumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Publikationsverlauf
Eingereicht: 17. Januar 2020
Angenommen: 05. Mai 2020
Artikel online veröffentlicht:
31. März 2021
© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26 (05) 908-915
- 2 Strub B, Schindele S, Sonderegger J, Sproedt J, von Campe A, Gruenert JG. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur Vol 2010; 35 (09) 725-729
- 3 Johnson KA. Posterior tibial tendon. In: Weiss AP, Goldfarb CA, Hentz VR, Raven RB, Slutsky DJ, Steinmann SP, Budoff JE, Calfee RP. eds. Textbook of hand and upper extremity surgery. Chicago: American Society for the Surgery of the Hand; 2013: 76-90
- 4 Creighton Jr JJ, Steichen JB. Complications in phalangeal and metacarpal fracture management. Results of extensor tenolysis. Hand Clin 1994; 10 (01) 111-116
- 5 Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y) 2014; 9 (01) 16-23
- 6 Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am 1998; 23 (05) 827-832
- 7 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 (08) 1260-1263
- 8 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 (04) 692-700
- 9 Ender J, Simon-Weidner R. Die Fixierung der trochanteren Bruche mit runden elastischen Condylennageln. Acta Chir Austriaca 1970; 2 (01) 40-42
- 10 Foucher G. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995; 20 (3 Pt 2): S86-S90
- 11 Schädel-Höpfner M, Wild M, Windolf J, Linhart W. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?. Arch Orthop Trauma Surg 2007; 127 (06) 435-440
- 12 Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am 2011; 36 (04) 610-616
- 13 Stahl S, Schwartz O. Complications of K-wire fixation of fractures and dislocations in the hand and wrist. Arch Orthop Trauma Surg 2001; 121 (09) 527-530
- 14 Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 1984; 66 (01) 114-123
- 15 Geissler WB. Cannulated percutaneous fixation of intra-articular hand fractures. Hand Clin 2006; 22 (03) 297-305 , vi
- 16 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) 2390-2395
- 17 Jann D, Calcagni M, Giovanoli P, Giesen T. Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws. Hand Surg Rehabil 2018; 37 (02) 99-103
- 18 Borbas P, Dreu M, Poggetti A, Calcagni M, Giesen T. Treatment of proximal phalangeal fractures with an antegrade intramedullary screw: a cadaver study. J Hand Surg Eur Vol 2016; 41 (07) 683-687
- 19 Avery 3rd DM, Klinge S, Dyrna F. et al. Headless compression screw versus Kirschner wire fixation for metacarpal neck fractures: a biomechanical study. J Hand Surg Am 2017; 42 (05) 392.e1-392.e6
- 20 Jones CM, Padegimas EM, Weikert N, Greulich S, Ilyas AM, Siegler S. Headless screw fixation of metacarpal neck fractures: a mechanical comparative analysis. Hand (N Y) 2019; 14 (02) 187-192
- 21 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 (02) 322-330.e2
- 22 Lalonde D, Eaton C, Amadio P, Jupiter J. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery. Instr Course Lect 2015; 64: 249-259
- 23 Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws. J Hand Microsurg 2016; 8 (03) 134-139
- 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 (02) 314-318
- 25 Romo-Rodríguez R, Arroyo-Berezowsky C. Osteosíntesis mínimamente invasiva con tornillos centromedulares canulados para fracturas de metacarpianos. Acta Ortop Mex 2017; 31 (02) 75-81
- 26 Beck CM, Horesh E, Taub PJ. Intramedullary screw fixation of metacarpal fractures results in excellent functional outcomes: a literature review. Plast Reconstr Surg 2019; 143 (04) 1111-1118
- 27 Evrard H, Nokerman B. [Centromedullary nailing in metacarpal fractures]. Acta Orthop Belg 1973; 39 (06) 1035-1044