Unstable Metacarpal and Phalangeal Fracture Treatment with Screws and Plates
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.
Available from: Sandip Hindocha
- "Manipulation, followed by ﬁxation with the use of K wires, which cross the IP joint, is required for fracture stabilization. Longitudinal fractures are less common and often require open reduction and internal ﬁxation with lag screws or cerclage wires . With intra-articular fractures of the interphalangeal joint, that involve more than one third of the joint surface, operative treatment is indicated. "
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ABSTRACT: The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner.
Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities.
A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management.
The Open Orthopaedics Journal 02/2012; 6(1):43-53. DOI:10.2174/1874325001206010043
- "Many fixation techniques are available including use of plates and screws, percutaneous pinning, cross K-wires and external fixations. Open reduction and internal fixation with plates and screws does provide rigid fixation, however, it needs periosteal stripping81415 and tendon adherence about plate or screws has been described.818–20 Moreover it is expensive as compared to the K-wires which we used as flexible nails. "
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ABSTRACT: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique.
Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength.
All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient.
Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.
Indian Journal of Orthopaedics 07/2008; 42(3):342-6. DOI:10.4103/0019-5413.39573 · 0.64 Impact Factor
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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). "
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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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