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The Cochrane Database of Systematic... Jul 2005Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures.... (Review)
Review
BACKGROUND
Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement.
OBJECTIVES
To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults.
SEARCH STRATEGY
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to July 2004), OVID MEDLINE In-Process (July 2004), EMBASE (1988 to 2004, week 29), the Internet, and reference lists of articles. No language restrictions were applied.
SELECTION CRITERIA
All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures.
DATA COLLECTION AND ANALYSIS
Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data.
MAIN RESULTS
Five studies met the inclusion criteria including a total of 252 participants. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior.
AUTHORS' CONCLUSIONS
No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. No single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another in result. Further research is definitely warranted.
Topics: Bandages; Braces; Casts, Surgical; Finger Injuries; Fracture Fixation; Fractures, Bone; Humans; Metacarpal Bones; Randomized Controlled Trials as Topic; Recovery of Function; Treatment Outcome
PubMed: 16034891
DOI: 10.1002/14651858.CD003210.pub3 -
Australian Family Physician Jun 2011Bennett fracture dislocation is an intra-articular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The... (Review)
Review
BACKGROUND
Bennett fracture dislocation is an intra-articular fracture of the base of the first metacarpal with resultant dislocation of the first carpometacarpal joint. The fracture is unstable, and with inadequate treatment leads to osteoarthritis, weakness and/or loss of function of the first carpometacarpal joint.
OBJECTIVE
This article reviews the current literature on Bennett fracture and describes the clinical assessment and management of a Bennett fracture.
DISCUSSION
Bennett fractures usually result from falling on an extended or abducted thumb or an impact onto a clenched fist. The patient presents with pain and loss of function of the first carpometacarpal joint. Management can involve closed reduction, with or without percutaneous Kirschner wire fixation, or open reduction and internal fixation, with adequate reduction and the maintenance of reduction being the key to a successful outcome. Due to the difficulty of management it is recommended that patients be referred to a specialist hand surgeon.
Topics: Carpometacarpal Joints; Humans; Intra-Articular Fractures; Joint Dislocations; Metacarpal Bones
PubMed: 21655486
DOI: No ID Found -
Journal of Healthcare Engineering 2022To explore the effect of joint use of external minifixator and titanium lockplate on total active motion (TAM) range and hand function recovery in comminuted metacarpal...
Effect of Joint Use of External Minifixator and Titanium Lockplate on Total Active Motion Range and Hand Function Recovery in Comminuted Metacarpal and Phalanx Fracture Patients.
OBJECTIVE
To explore the effect of joint use of external minifixator and titanium lockplate on total active motion (TAM) range and hand function recovery in comminuted metacarpal and phalanx fracture patients.
METHODS
The medical data of 70 patients with comminuted metacarpal and phalanx fracture treated in our hospital from June 2017 to June 2020 were screened for the retrospective study, and the patients were divided into the control group (Kirschner wire internal fixation) and the study group (an external minifixator with titanium lockplate) according to the treatment modalities, with 35 cases each. After treatment, the clinical efficacy of patients was compared between the two groups.
RESULTS
No between-group differences in patients' general data were observed ( > 0.05); the time for hospital stay and fracture healing was obviously shorter in the study group than that in the control group ( < 0.05); after treatment, the study group obtained significantly higher TAM range good rate ( < 0.05), significantly higher Carroll hand function test pass rate ( < 0.05), and obviously better grip strength of both hands and score on digital opposition of thumb than those in the control group ( < 0.05); and after surgery, the study group had significantly lower incidence rates of complications such as infection, local inflammation, displacement of bone, and adhesion of tendon that those in the control group ( < 0.05).
CONCLUSION
Joint use of an external minifixator and titanium lockplate can effectively promote the TAM range and accelerate hand function recovery for comminuted metacarpal and phalanx fracture patients and is conducive to reducing the incidence of postoperative complications, which is safe and has significant efficacy.
Topics: Fractures, Comminuted; Humans; Metacarpal Bones; Recovery of Function; Retrospective Studies; Titanium; Treatment Outcome
PubMed: 35126920
DOI: 10.1155/2022/3566364 -
Anatomical Record (Hoboken, N.J. : 2007) Dec 2022Racehorses are exposed to repetitive overload during training and competition, causing joint hyperextension, tissue fatigue, and ultimately skeletal failure. Some degree...
Racehorses are exposed to repetitive overload during training and competition, causing joint hyperextension, tissue fatigue, and ultimately skeletal failure. Some degree of bone changes, such as sclerosis, are expected in equine athletes, as adaptation to the biomechanical rigors of training and racing. Understanding the imaging characteristics of the equine joint surface and subchondral bone would allow earlier detection of injuries or adaptation, improving prognosis and training programs. This study sought to describe the joint surface structural patterns and the periarticular structures of the third metacarpal bone (MC3). Both forelimbs of eight horses engaged in daily training programs, aged 3-5 years, which were euthanized for reasons unrelated to the metacarpophalangeal (MCP) joints, were collected. Specimens were evaluated through macroscopic inspection, radiography, ultrasonography, and microscopic examinations, such as optical microscopy and microtomography. Analysis of the microtomography images showed that 50% of the samples had higher trabecular thickness in the lateral condyle. Comparison of each imaging examination revealed that ultrasound images were most closely related to the histological examination (p = .29) in terms of sensitivity, while macroscopic and radiographic examinations differed most between evaluators. Finally, the irregularities and modifications observed in the articular cartilage surface and subchondral bone were normal adaptations of the anatomical structures of trained racehorses, which should be considered during clinical examination.
Topics: Horses; Animals; Metacarpal Bones; Metacarpus; Physical Conditioning, Animal; Cartilage, Articular; Horse Diseases
PubMed: 35338614
DOI: 10.1002/ar.24918 -
German Medical Science : GMS E-journal 202210% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries....
10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System. Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters. Three-quarters of the patients were male. The mean age at the time of surgery was 39.3±16 years. Falling was the leading cause for hand fractures, and the most common were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. Level: IV; outcome-study, retrospective.
Topics: Bone Plates; Female; Finger Injuries; Fracture Healing; Fractures, Bone; Hand Injuries; Humans; Male; Metacarpal Bones; Retrospective Studies; Treatment Outcome
PubMed: 35465637
DOI: 10.3205/000305 -
Journal of Anatomy Jul 2019Trabecular bone remodels during life in response to loading and thus should, at least in part, reflect potential variation in the magnitude, frequency and direction of...
Trabecular bone remodels during life in response to loading and thus should, at least in part, reflect potential variation in the magnitude, frequency and direction of joint loading across different hominid species. Here we analyse the trabecular structure across all non-pollical metacarpal distal heads (Mc2-5) in extant great apes, expanding on previous volume of interest and whole-epiphysis analyses that have largely focused on only the first or third metacarpal. Specifically, we employ both a univariate statistical mapping and a multivariate approach to test for both inter-ray and interspecific differences in relative trabecular bone volume fraction (RBV/TV) and degree of anisotropy (DA) in Mc2-5 subchondral trabecular bone. Results demonstrate that whereas DA values only separate Pongo from African apes (Pan troglodytes, Pan paniscus, Gorilla gorilla), RBV/TV distribution varies with the predicted loading of the metacarpophalangeal (McP) joints during locomotor behaviours in each species. Gorilla exhibits a relatively dorsal distribution of RBV/TV consistent with habitual hyper-extension of the McP joints during knuckle-walking, whereas Pongo has a palmar distribution consistent with flexed McP joints used to grasp arboreal substrates. Both Pan species possess a disto-dorsal distribution of RBV/TV, compatible with multiple hand postures associated with a more varied locomotor regime. Further inter-ray comparisons reveal RBV/TV patterns consistent with varied knuckle-walking postures in Pan species in contrast to higher RBV/TV values toward the midline of the hand in Mc2 and Mc5 of Gorilla, consistent with habitual palm-back knuckle-walking. These patterns of trabecular bone distribution and structure reflect different behavioural signals that could be useful for determining the behaviours of fossil hominins.
Topics: Animals; Gorilla gorilla; Hand; Hominidae; Humans; Locomotion; Metacarpal Bones; Pan paniscus; Pan troglodytes; Pongo abelii; Pongo pygmaeus; Posture; Walking
PubMed: 31099419
DOI: 10.1111/joa.12966 -
Medicine Dec 2021Although percutaneous intramedullary nailing of metacarpal fractures is a straightforward and reliable technique, it is not without complications, and patients...
Although percutaneous intramedullary nailing of metacarpal fractures is a straightforward and reliable technique, it is not without complications, and patients experience different outcomes. This study analyzed factors affecting fracture healing time and complication rates in patients who underwent percutaneous intramedullary fixation of metacarpal fractures.This study was a retrospective review of the 25 patients who underwent retrograde percutaneous Kirschner wire (K-wire) nailing for fracture of the metacarpal shaft or neck at a military hospital between May 2016 and October 2018. Correlation study and multiple regression analysis were performed to evaluate variables (age, smoking history in pack-years, body-mass index, fracture site, number of K-wires used) that affect time to bone union. Clinical features of patients with metacarpal neck fractures and those with metacarpal shaft fractures were also compared.The metacarpal shaft fractures (as opposed to metacarpal neck fractures) and higher number of K-wire used were associated with longer time to bone union. Mean union time was significantly longer for metacarpal shaft fracture (8.6 weeks) than for metacarpal neck fracture (6.1 weeks) and for patients who received more K-wires than for those who received less (regression coefficient 1.307). One patient suffered fixation failure and required revision operation, and another experienced superficial infection which was treated with intravenous antibiotics.Percutaneous intramedullary nailing is an effective technique for metacarpal fractures, but fracture site and number of K-wire used affect time to achieve bone union.
Topics: Adult; Body Mass Index; Bone Wires; Female; Fracture Fixation, Intramedullary; Fractures, Bone; Hand Injuries; Humans; Male; Metacarpal Bones; Retrospective Studies
PubMed: 34918646
DOI: 10.1097/MD.0000000000027968 -
BMC Musculoskeletal Disorders Dec 2013High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However,...
A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study.
BACKGROUND
High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites.
METHODS
12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%95).
RESULTS
Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH2 trabecular number) to .99 (MS3 polar moment of inertia); CV% varied from < 1 (MS2 vBMD) to 6 (MS3 marrow space diameter); RMSCV% varied from < 1 (MH2 full bone vBMD) to 7 (MS3 marrow space diameter); and LSC%95 varied from 2 (MS2 full bone vBMD to 21 (MS3 marrow space diameter). Cortical porosity measures were the exception; RMSCV% varying from 19 (MS3) to 42 (UUD). No scans were stopped for discomfort. 5% (5/104) were repeated due to motion during imaging. 8% (8/104) of final images had motion artifact graded > 3 on 5 point scale.
CONCLUSION
In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.
Topics: Adult; Aged; Arthritis, Rheumatoid; Clinical Protocols; Female; Healthy Volunteers; Humans; Male; Metacarpal Bones; Middle Aged; Radius; Tomography, X-Ray Computed; Young Adult
PubMed: 24364867
DOI: 10.1186/1471-2474-14-367 -
Journal of Orthopaedic Surgery and... Aug 2022To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft...
OBJECTIVE
To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft fractures.
MATERIALS AND METHODS
Horizontal oblique metacarpal shaft fractures were created in 21 artificial metacarpal bones and fixed using one of the three methods: (1) two lag screws, (2) a regular plate, and (3) a locking plate. All the specimens were subjected to the cantilever bending test performed using a material testing machine to enable recording of the force-displacement data of the specimens before failure. The Kruskal-Wallis test was used to compare failure force and stiffness values among the three fixation methods.
RESULTS
The mean failure force of the two lag screw group (78.5 ± 6.6 N, mean + SD) was higher than those of the regular plate group (69.3 ± 17.6 N) and locking plate group (68.2 ± 14.2 N). However, the mean failure force did not significantly differ among the three groups. The mean stiffness value of the two lag screw group (17.8 ± 2.6 N/mm) was lower than those of the regular plate group (20.2 ± 10.5 N/mm) and locking plate group (21.8 ± 3.8 N/mm). However, the mean stiffness value did not significantly differ among the three groups.
CONCLUSION
The fixation strength of two lag screw fixation did not significantly differ from that of regular and locking bone plate fixation, as indicated by the measurement of the ability to sustain force and stiffness.
Topics: Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones
PubMed: 35922799
DOI: 10.1186/s13018-022-03267-2 -
Animal Bioscience May 2023Dietary phytase increases bioavailability of phytate-bound phosphorus (P) in pig nutrition affecting dietary calcium (Ca) to P ratio, intestinal uptake, and systemic...
OBJECTIVE
Dietary phytase increases bioavailability of phytate-bound phosphorus (P) in pig nutrition affecting dietary calcium (Ca) to P ratio, intestinal uptake, and systemic utilization of both minerals, which may contribute to improper bone mineralization. We used phytase to assess long-term effects of two dietary available P (aP) levels using a one-phase feeding system on gene expression related to Ca and P homeostasis along the intestinal tract and in the kidney, short-chain fatty acids in stomach, cecum, and colon, serum, and bone parameters in growing gilts and barrows.
METHODS
Growing pigs (37.9±6.2 kg) had either free access to a diet without (Con; 75 gilts and 69 barrows) or with phytase (650 phytase units; n = 72/diet) for 56 days. Samples of blood, duodenal, jejunal, ileal, cecal, and colonic mucosa and digesta, kidney, and metacarpal bones were collected from 24 pigs (6 gilts and 6 barrows per diet).
RESULTS
Phytase decreased daily feed intake and average daily gain, whereas aP intake increased with phytase versus Con diet (p<0.05). Gilts had higher colonic expression of TRPV5, CDH1, CLDN4, ZO1, and OCLN and renal expression of TRPV5 and SLC34A3 compared to barrows (p<0.05). Phytase increased duodenal expression of TRPV5, TRPV6, CALB1, PMCA1b, CDH1, CLDN4, ZO1, and OCLN compared to Con diet (p<0.05). Furthermore, phytase increased expression of SCL34A2 in cecum and of FGF23 and CLDN4 in colon compared to Con diet (p<0.05). Alongside, phytase decreased gastric propionate, cecal valerate, and colonic caproate versus Con diet (p<0.05). Phytase reduced cortical wall thickness and index of metacarpal bones (p<0.05).
CONCLUSION
Gene expression results suggested an intestinal adaptation to increased dietary aP amount by increasing duodenal trans- and paracellular Ca absorption to balance the systemically available Ca and P levels, whereas no adaption of relevant gene expression in kidney occurred. Greater average daily gain in barrows related to higher feed intake.
PubMed: 36397701
DOI: 10.5713/ab.22.0251