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Hand (New York, N.Y.) Sep 2016Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. A comprehensive review of the literature was performed to help... (Review)
Review
Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.
Topics: Carpal Bones; Humans; Metacarpal Bones; Radiography; Synostosis; Wrist Joint
PubMed: 27698627
DOI: 10.1177/1558944715614860 -
Journal of Anatomy Jul 2022The trabecular bone morphology of adult extant primates has been shown to reflect mechanical loading related to locomotion. However, ontogenetic studies of humans and...
The trabecular bone morphology of adult extant primates has been shown to reflect mechanical loading related to locomotion. However, ontogenetic studies of humans and other mammals suggest an adaptive lag between trabecular bone response and current mechanical loading patterns that could result in adult trabecular bone morphology reflecting juvenile behaviours. This study investigates ontogenetic changes in the trabecular bone structure of the third metacarpal of mountain gorillas (Gorilla beringei beringei; n = 26) and western lowland gorillas (Gorilla gorilla gorilla; n = 26) and its relationship to expected changes in locomotor loading patterns. Results show that trabecular bone reflects predicted mechanical loading throughout ontogeny. Bone volume fraction, trabecular thickness and trabecular number are low at birth and increase with age, although degree of anisotropy remains relatively stable throughout ontogeny. A high concentration of bone volume fraction can be observed in the distopalmar region of the third metacarpal epiphysis in early ontogeny, consistent with the high frequency of climbing, suspensory and other grasping behaviours in young gorillas. High trabecular bone concentration increases dorsally in the epiphysis during the juvenile period as terrestrial knuckle-walking becomes the primary form of locomotion. However, fusion of the epiphysis does not take place until 10-11 years of age, and overall trabecular structure does not fully reflect the adult pattern until 12 years of age, indicating a lag between adult-like behaviours and adult-like trabecular morphology. We found minimal differences in trabecular ontogeny between mountain and western lowland gorillas, despite presumed variation in the frequencies of arboreal locomotor behaviours. Altogether, ontogenetic changes in Gorilla metacarpal trabecular structure reflect overall genus-level changes in locomotor behaviours throughout development, but with some ontogenetic lag that should be considered when drawing functional conclusions from bone structure in extant or fossil adolescent specimens.
Topics: Animals; Cancellous Bone; Gorilla gorilla; Hominidae; Locomotion; Mammals; Metacarpal Bones
PubMed: 35122239
DOI: 10.1111/joa.13630 -
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 -
Microsurgery Mar 2022Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone...
BACKGROUND
Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone vascularization.
PATIENTS AND METHODS
Surgery was performed between 64 and 499 days after the initial bone osteosynthesis. The average age was 27.6 (range 16-32) years. Nonunion was caused by excessive periosteal removal in two patients, extensive open trauma in three. Four nonunions were diaphyseal, one metaphyseal. A periosteal medial femoral condyle free flap was raised on the descending genicular artery for four patients, the superomedial genicular artery for one. After osteosynthesis with a plate, the flap was wrapped around the metacarpal, overlapping the bone proximally and distally. The recipient vessel were the dorsal branch of the radial artery and a vena comitans in the anatomical snuffbox in four patients, at the base of the first webspace in one.
RESULTS
The flap size ranged from 5 × 3.5 cm to 8 × 4 cm. No postoperative complication occurred. Radiological bone union was achieved 3 to 8 months after surgery. One patient had a full range of motion, one a slight extension lag of the proximal interphalangeal joint, two moderate joint stiffness of the proximal interphalangeal or metacarpophalangeal joint (one requiring plate removal and extensor tenolysis), one severe stiffness that allowed using a hook grip which was the aim of the surgery.
CONCLUSION
In case of metacarpal nonunion with impaired bone vascularization, the periosteal medial femoral condyle free flap provides an effective and biomimetic approach to bone healing.
Topics: Adolescent; Adult; Femur; Fractures, Ununited; Free Tissue Flaps; Humans; Metacarpal Bones; Range of Motion, Articular; Young Adult
PubMed: 34636060
DOI: 10.1002/micr.30826 -
JNMA; Journal of the Nepal Medical... Jul 2021Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early...
Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study.
INTRODUCTION
Hand injuries metacarpal fractures are common and it accounts about 14 to 28%. Mini-plate fixation in unstable metacarpal fractures provides absolute stability and early mobilization of fingers to reduce complications. The purpose of this study is to find out the prevalence of open reduction and internal fixation with mini-plate and screws for management of unstable metacarpal fracture among hand injuries done in a tertiary care center.
METHODS
This was a descriptive cross-sectional study done from February 2019 and January 2021 in a tertiary care center with unstable isolated metacarpal fracture treated with mini-plate fixation and were followed up for six months duration. Ethical approval and informed written consent were taken from all patients. The outcome was assessed by the American Society for Surgery of the Hand Total Active Flexion Score. Convenient sampling method was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Statistical Package for Social Sciences used for analysis.
RESULTS
Out of 250 patients who underwent hand surgeries, open reduction and internal fixation with mini-plate and screws for unstable metacarpal fracture were done in 32 (12.8%) (8.66-16.94 at 95% Confidence Interval). The mean time of fracture union was 6.78±1.008 weeks. Functional outcome according to American Society for Surgery of the Hand Total Active Flexion score was excellent in 25 (78.2%), good in 6 (18.8%), and poor in 1 (3%) patient.
CONCLUSIONS
Fixation of metacarpal fracture by mini-plate and screws was required in fewer patients. Mini-plate fixation provides better stability and early mobilization for unstable metacarpal fractures to achieve a good functional outcome.
Topics: Bone Plates; Bone Screws; Cross-Sectional Studies; Fracture Fixation, Internal; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones; Tertiary Care Centers; Treatment Outcome
PubMed: 34508497
DOI: 10.31729/jnma.6846 -
Journal of Orthopaedic Surgery and... Jul 2021Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking...
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.
Topics: Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Fractures, Bone; Humans; Materials Testing; Metacarpal Bones
PubMed: 34233702
DOI: 10.1186/s13018-021-02575-3 -
Journal of the American College of... Jun 2021This case report documents a rare inversion of a closed metacarpal head fracture in the setting of polytrauma. Although rare, hemispherical articular bones can fracture...
This case report documents a rare inversion of a closed metacarpal head fracture in the setting of polytrauma. Although rare, hemispherical articular bones can fracture and rotate 180°. Because of the symmetry of the bone and the rarity of an inverted, metacarpal head fracture, a delay in diagnosis and subsequent treatment can occur, which can lead to a poor outcome. This is particularly true in the setting of polytrauma. A 38-year-old male, polytrauma patient presented to the emergency department (ED) after falling off a bridge and being struck by an oncoming vehicle. He presented with multiple surgical fractures of the upper and lower extremities as well as his pelvis. Three days after he was brought to the ED, x-rays were performed of his painful left hand, which revealed an extra-articular third metacarpal head fracture, for which he underwent open reduction of the closed fracture. Both collateral ligaments were intact and the head fragment had inverted within the constraints of these ligaments. Some of the ligament and capsular tissue remained attached to the head fragment along the radial and ulnar margins but was otherwise entirely covered with cartilage. The reduction maneuver was difficult but after the reduction was achieved, the fracture appeared stable and no internal fixation was used. Post reduction, the injury was splinted for 2 weeks and then early motion was allowed. The fracture has since healed, and the patient has attained near-full function of the finger and joint.
PubMed: 34136879
DOI: 10.1002/emp2.12428 -
Hand (New York, N.Y.) Jan 2023Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary... (Review)
Review
Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. A comprehensive literature search was performed using electronic databases for both clinical and biomechanical studies in relation to RIS fixation published from 2000 to 2020. A total of 19 studies (13 clinical and 6 biomechanical) met the inclusion criteria. The clinical studies examined 603 metacarpal fractures and demonstrated adequate functional outcomes in terms of grip strength, total active motion, and time to return to work. The biomechanical studies examined 80 metacarpal fractures, finding that load to failure in RISs was often equal to or higher than Kirschner wires but less than plate and screws. The complication rate in reviewed studies was 2.8%, with the most prevalent complications being stiffness and extension lag. RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality.
Topics: Humans; Fracture Fixation, Internal; Metacarpal Bones; Fractures, Bone; Bone Screws; Bone Wires; Hand Injuries
PubMed: 33530708
DOI: 10.1177/1558944720988073 -
Joint Diseases and Related Surgery 2022This study aims to investigate whether plating after lengthening in patients with phalanges and metacarpals deficiency could significantly shorten the duration of...
OBJECTIVES
This study aims to investigate whether plating after lengthening in patients with phalanges and metacarpals deficiency could significantly shorten the duration of external fixation and decrease bone healing index.
PATIENTS AND METHODS
Between February 2010 and December 2018, 11 phalanges in nine patients (6 males, 3 females; mean age: 28.4±4.4 years; range, 22 to 35 years) and nine metacarpals in six patients (2 males, 4 females; mean age: 21.0±2.9 years; range, 16 to 25 years) were lengthened at a rate of 0.25 mm in two increments. A unilateral external fixator was applied in all cases. A locking compression plate was applied at the end of the distraction period before the external fixator was removed. Removal of the plate was considered two years after the internal fixation.
RESULTS
The desired length and bone consolidation were achieved in all cases. The additional lengths achieved in the phalanges and metacarpals group were 18.3 mm and 27.7 mm on average, respectively. The bone healing indexes in the phalanges and metacarpals were 1.33 and 1.44 mo/cm, respectively. No significant difference was observed in the pre- and postoperative range of motion of involved metacarpophalangeal joint of both phalangeal (95% CI: -0.469~1.014, t=0.820, p=0.432) and metacarpal (95% CI: -0.689~0.975, t=0.420, p=0.689) lengthening cases. Only one case of minor complication (track infection) occurred.
CONCLUSION
Plating after lengthening is an ideal method for phalanges and metacarpals deficiency. Its advantages include shorter duration of external fixation, lower complication rate, and early functional recovery.
Topics: Adolescent; Adult; External Fixators; Female; Finger Phalanges; Fracture Fixation; Humans; Male; Metacarpal Bones; Osteogenesis, Distraction; Young Adult
PubMed: 35852184
DOI: 10.52312/jdrs.2022.566