Unstable Metacarpal and Phalangeal Fracture Treatment with Screws and Plates
ABSTRACT Plate and screw fixation of the metacarpals and phalanges has limited indications but can provide crucial assistance to the reconstructive hand surgeon in the treatment of complex fractures. Screws are indicated for unstable, long oblique or spiral fractures of the metacarpals and phalanges, intraarticular fractures with articular surface involvement in excess of 25% with or without comminution, and intraarticular condylar, T-condylar, and Y-condylar fractures. Plates at the metacarpal level are indicated for segmental defects with substance loss, fractures with extreme comminution, and unstable short oblique or transverse diaphyseal fractures. Plate fixation of phalangeal fractures is seldom necessary but helpful in treating segmental defects or extreme comminution of diaphysis or metaphysis as well as intraarticular T- or Y-condylar fractures. Screw and plate fixation at the metacarpal levels, when appropriately applied, renders rigid osteosynthesis while inflicting little to no interference on the surrounding soft tissues. Screws can be applied with little to no soft tissue interference throughout the proximal phalanx and proximal and distal aspects of the middle phalanx. Plate fixation for middle phalangeal fractures is limited to salvage situations for preservation of skeletal length. The essentials for successful use of implants are a hand surgeon well versed in a variety of internal fixation techniques including the Association for the Study of Internal Fixation (ASIF) technique of screw and plate fixation, a meticulous respect for, and protection of, the soft tissues, and a facility for delivery of functional aftercare.
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- "Moreover, the whole procedure is time-consuming increasing considerably the ischemic time. Screw fixation using the lag screw principle can only be applied to oblique surfaces (Hastings 1987). "
ABSTRACT: We present our experience from 108 partially or totally amputated digits in 87 patients which were replanted or revascularized successfully by the Orthopaedic Microsurgical Team at the University of Ioannina Medical School in Greece, during the period from 1978 to 1994. The majority of the patients were men involved in occupational accidents. Bone shortening always preceded the osteosynthesis and the vessel anastomosis, and most of the available methods for osteosynthesis were used, including small plates, single lag screws, crossed Kirschner wires, a combination of intraosseus cerclage wires and Kirschner wires, and intramedullary Kirschner wires. Our findings suggest that the most appropriate method for bone fixation in digital replantation is the insertion of one intramedullary Kirschner wire, supplemented by another wire which is inserted at the end of the procedure. This technique was found superior for the following reasons: 1) it's simplicity and the speed of the technique reduced the ischemic time; (2) less bone exposure was required; (3) less skeletal mass was needed for fixation; and (4) prior to the insertion of the second Kirschner wire, rotation of the replanted part was possible if it was necessary to re-align the vessels or to correct any rotational deformity.Acta orthopaedica Scandinavica. Supplementum 07/1995; 264(s264):19-22. DOI:10.3109/17453679509157159
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ABSTRACT: The fracture classification of Gustilo and Anderson, originally developed from experience with tibial fractures and frequently applied to long bones, has never been applied to injuries of the hand. In order to evaluate the applicability of this fracture classification to open fractures of the hand, 146 injured hands in 143 consecutive patients were retrospectively reviewed. The incidence of infection and outcome were analysed with respect to three methods of classification: mechanism of injury, injury pattern, and fracture grade. Human bites were not included in this review.
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ABSTRACT: This paper introduces a newly designed dynamic traction splint for the management of digital intea-articular fractures. These fractures, particularly when involving comminution of the joint surface, often result in limitation of hand function due to joint stiffness, tendon adhesion, and chronic pain. Fourteen patients with intea-articular fractures were studied. Thirteen cases involved the proximal interphalangeal joint of the finger and one case involved the interphalangeal joint of the thumb. The splint, a compact, lateral-hinge type, was designed to apply dynamic traction to the fracture. Follow-up at 7 months (range 2 to 19 months) demonstrated functional, pain-free movement. The mean total arc of active motion was 80° in the proximal interphalangeal joints of the fingers and 60° in the interphalangeal joint of the thumb. Radiologic examination demonstrated remodeling of the articular surfaces with maintenance of joint space. The results, when compared with those of other treatment methods, support the use of this splint and treatment program for the management of difficult intea-articular fractures.Journal of Hand Therapy 01/1992; 5(1):16–24. DOI:10.1016/S0894-1130(12)80193-1 · 1.81 Impact Factor