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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ABSTRACT: Eleven patients with unstable extra-articular fractures of the base of the first metacarpal with angulations more than 30° uncorrected by closed reduction were treated by open reduction and tension band fixation. Ten men and one woman with a mean age of 36.18 years. Fall on a stretched hand was the cause in eight while a punch in two and trauma from a basket ball in one. The mean follow up period was 12.45 months. All fractures united within a mean of 4.36 weeks. Patients were evaluated by subjective and objective criteria: the mean of pain was 0.5, quick-DASH was 10.48 and Kapandji score was 9.8. While the mean of the grip strength was 94 % and the pinch strength was 99 % of the contra lateral hand. There were no complications except local irritation of the k-wires in two patients that had to be removed at 4 months. Tension band technique proved to be a valuable technique which is easy to apply and gives rigid fixation with early mobilization.12/2014; 6(2):65-68. DOI:10.1007/s12593-014-0137-3
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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
Chapter: Metacarpal fracture06/2014;