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Hand Clinics Feb 2024The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant... (Review)
Review
The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant functional impairment for patients and societal costs. Operative intervention is typically required in these cases, but the technique can vary depending on each individual patient scenario. This article provides an overview of nonunions of the metacarpals and phalanges in the hand, including incidence, risk factors, current treatment options, and postoperative care.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Fracture Fixation, Internal; Hand Injuries; Finger Phalanges
PubMed: 37979984
DOI: 10.1016/j.hcl.2023.09.003 -
The Journal of Hand Surgery, European... Sep 2023Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the... (Review)
Review
Peri-articular fractures of the hand are common injuries. Long-term consequences can be relatively innocuous or severely disabling. Due to the specific anatomy of the hand, avulsion fractures are likely more common here than anywhere else in the body and often occur at or near joints. The management of peri-articular fractures of the hand requires consideration of both the articular reduction and the status of ligament and tendon attachments. In general, these fractures can be treated non-operatively. Operative treatment can be percutaneous or open and should be individualized.
Topics: Humans; Hand; Upper Extremity; Intra-Articular Fractures; Fractures, Bone; Neurosurgical Procedures
PubMed: 37704023
DOI: 10.1177/17531934231184132 -
Hand Clinics Aug 2023Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are... (Review)
Review
Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are stiffness and malunion. These can be highly challenging problems for the hand surgeon. In this article, we discuss complications after phalangeal and metacarpal fractures and treatment strategies for these complications.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Finger Phalanges
PubMed: 37453755
DOI: 10.1016/j.hcl.2023.02.002 -
Scientific Reports Oct 2023Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss... (Observational Study)
Observational Study
Rheumatoid arthritis (RA) causes bone loss, only partly related to inflammation. The impact of RA treatments on bone metabolism and their ability to mitigate bone loss remains uncertain. The primary goal of our study was to examine the influence of abatacept on serum levels of markers and regulators involved in bone turnover. Secondary objectives included evaluating changes in bone mineral density (BMD), bone health parameters, erosions, and exploring potential correlations among these parameters. We conducted a prospective observational study on patients with active seropositive RA failure to biological disease modifying anti-rheumatic drugs initiating treatment with abatacept. We measured at baseline and after 1, 2, 3, 6, 9 and 12 months: serum bone turnover markers (CTX, P1nP, B-ALP), bone modulators (Dkk-1, sclerostin, vitamin D, PTH, OPG and RANKL), BMD and radiographic parameters (modified Sharp van der Heijde score [mSvdH], bone health index [BHI] and metacarpal index [MCI]). Disease activity and glucocorticoid intake was monitored. 33 patients were enrolled in the study. We found a significant increase in markers of bone formation (B-ALP and P1nP) from baseline to M6 and M12. PTH increased significantly at M6 but not at M12. All other bone markers and modulators did not change. We found a significant decrease in BHI and MCI from baseline to M12 (median difference - 0.17 95% CI - 0.42 to - 0.10, p 0.001 and - 0.09 95% CI - 0.23 to - 0.07, respectively). BMD at femoral neck transitorily decreased at M6 (mean difference - 0.019 g/cm 95% CI - 0.036 to - 0.001 p 0.04). BMD at total hip, lumbar spine and mSvdH score did not change significantly. P1nP delta at M12 correlated with delta mSvdH. Treatment with abatacept was associated with a significant increase in bone formation markers. The secondary and transient increase in PTH serum levels may be responsible of the transitory bone loss.
Topics: Humans; Abatacept; Antirheumatic Agents; Arthritis, Rheumatoid; Biomarkers; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Bone Remodeling; Prospective Studies
PubMed: 37821541
DOI: 10.1038/s41598-023-44374-2 -
Deutsches Arzteblatt International Dec 2023Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The... (Review)
Review
BACKGROUND
Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures.
METHODS
This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature.
RESULTS
The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis.
CONCLUSION
Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Upper Extremity; Treatment Outcome
PubMed: 37963039
DOI: 10.3238/arztebl.m2023.0226 -
Hand Clinics Nov 2023Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative... (Review)
Review
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Bone Screws; Fracture Fixation, Internal; Fracture Fixation, Intramedullary
PubMed: 37827601
DOI: 10.1016/j.hcl.2023.05.014 -
Hand Clinics Feb 2024Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger... (Review)
Review
Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger alignment including malrotation and severe angulation as well as intra-articular deformities can lead to functional deficits which may benefit from operative intervention. There are numerous surgical options to correct malunions and the correct choice varies based on the injury pattern, concurrent injuries/complications, and surgeon's preference. While these surgeries can be technically demanding, successful treatment can lead to good results with satisfactory deformity correction and patient function.
Topics: Humans; Metacarpal Bones; Rotation; Osteotomy; Fractures, Bone; Fractures, Malunited
PubMed: 37979986
DOI: 10.1016/j.hcl.2023.08.005 -
European Journal of Orthopaedic Surgery... Oct 2023The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium...
PURPOSE
The treatment of irreducible or severely displaced metacarpal and phalangeal bone fractures is still much debated. The recent development of the bioabsorbable magnesium K-wire is thought to allow effective treatment upon insertion via intramedullary fixation by minimizing articular cartilage injuries without discomfort until pin removal and drawbacks, such as pin track infection and metal plate removal. Therefore, this study investigated and reported the effects of intramedullary fixation with the bioabsorbable magnesium K-wire in unstable metacarpal and phalangeal bone fractures.
METHODS
This study included 19 patients admitted to our clinic for metacarpal or phalangeal bone fractures from May 2019 to July 2021. As a result, 20 cases were examined among these 19 patients.
RESULTS
Bone union was observed in all 20 cases, with a mean bone union time of 10.5 (SD 3.4) weeks. Reduction loss was observed in six cases, all showing dorsal angulation with a mean angle of 6.6° (SD 3.5°) at 4.6 weeks as compared with that noted in the unaffected side. The gas cavity upon H gas formation was first observed approximately 2 weeks postoperatively. The mean DASH score was 33.5 for instrumental activity and 9.5 for work/task performance. No patient complained of notable discomfort after surgery.
CONCLUSION
Intramedullary fixation with the bioabsorbable magnesium K-wire may be used for unstable metacarpal and phalanx bone fractures. This wire is expected to be a particularly favorable indication for shaft fractures, although care should be taken due to the possibility of complications related to rigidity and deformity.
Topics: Humans; Metacarpal Bones; Absorbable Implants; Magnesium; Fracture Fixation, Intramedullary; Fractures, Bone; Bone Wires; Fracture Fixation, Internal
PubMed: 36906666
DOI: 10.1007/s00590-023-03503-3 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal... (Review)
Review
Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.
Topics: Humans; Female; Thumb; Trapezium Bone; Osteoarthritis; Arthroplasty, Replacement; Pain; Carpometacarpal Joints; Arthroplasty
PubMed: 38000508
DOI: 10.1016/j.otsr.2023.103772