Biomechanical analysis of plate versus K-wire fixation for metacarpal shaft fractures with wedge-shaped bone defects.
K-wire
Locked plate
Metacarpal shaft fracture
Wedge-shaped defect
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
03 May 2024
03 May 2024
Historique:
received:
31
10
2023
accepted:
29
04
2024
medline:
4
5
2024
pubmed:
4
5
2024
entrez:
3
5
2024
Statut:
epublish
Résumé
Metacarpal shaft fracture is a common type of hand fracture. Numerous studies have explored fixing transverse fractures in the midshaft of the metacarpal bone. However, this section of the metacarpal bone is often susceptible to high-energy injury, resulting in comminuted fracture or bone loss. In such cases, wedge-shaped bone defects can develop in the metacarpal shaft, increasing the difficulty of performing fracture fixation. Notably, the research on this type of fracture fixation is limited. This study compared the abilities of four fixation methods to fix metacarpal shaft fractures with wedge-shaped bone defects. In total, 28 artificial metacarpal bones were used. To create wedge-shaped bone defects, an electric saw was used to create metacarpal shaft fractures at the midshaft of each bone. The artificial metacarpal bones were then divided into four groups for fixation. The bones in the first group were fixed with a dorsal locked plate (DP group), those in the second group were fixed with a volar locked plate (VP group), and those in the third group were fixed by combining dorsal and volar locked plates (DP + VP group), and those in the fourth group were fixed with two K-wires (2 K group). Cantilever bending tests were conducted using a material testing machine to measure yielding force and stiffness. The four groups' fixation capabilities were then assessed through analysis of variance and Tukey's test. The DP + VP group (164.1±44.0 N) achieved a significantly higher yielding force relative to the 2 K group (50.7 ± 8.9 N); the DP group (13.6 ± 3.0 N) and VP group (12.3 ± 1.0 N) did not differ significantly in terms of yielding force, with both achieving lower yielding forces relative to the DP + VP group and 2 K group. The DP + VP group (19.8±6.3 N/mm) achieved the highest level of stiffness, and the other three groups did not differ significantly in terms of stiffness (2 K group, 5.4 ± 1.1 N/mm; DP group, 4.0 ± 0.9 N/mm; VP group, 3.9 ± 1.9 N/mm). The fixation method involving the combined use of dorsal and volar locked plates (DP + VP group) resulted in optimal outcomes with respect to fixing metacarpal shaft fractures with volar wedge bone defects.
Sections du résumé
BACKGROUND
BACKGROUND
Metacarpal shaft fracture is a common type of hand fracture. Numerous studies have explored fixing transverse fractures in the midshaft of the metacarpal bone. However, this section of the metacarpal bone is often susceptible to high-energy injury, resulting in comminuted fracture or bone loss. In such cases, wedge-shaped bone defects can develop in the metacarpal shaft, increasing the difficulty of performing fracture fixation. Notably, the research on this type of fracture fixation is limited. This study compared the abilities of four fixation methods to fix metacarpal shaft fractures with wedge-shaped bone defects.
METHODS
METHODS
In total, 28 artificial metacarpal bones were used. To create wedge-shaped bone defects, an electric saw was used to create metacarpal shaft fractures at the midshaft of each bone. The artificial metacarpal bones were then divided into four groups for fixation. The bones in the first group were fixed with a dorsal locked plate (DP group), those in the second group were fixed with a volar locked plate (VP group), and those in the third group were fixed by combining dorsal and volar locked plates (DP + VP group), and those in the fourth group were fixed with two K-wires (2 K group). Cantilever bending tests were conducted using a material testing machine to measure yielding force and stiffness. The four groups' fixation capabilities were then assessed through analysis of variance and Tukey's test.
RESULTS
RESULTS
The DP + VP group (164.1±44.0 N) achieved a significantly higher yielding force relative to the 2 K group (50.7 ± 8.9 N); the DP group (13.6 ± 3.0 N) and VP group (12.3 ± 1.0 N) did not differ significantly in terms of yielding force, with both achieving lower yielding forces relative to the DP + VP group and 2 K group. The DP + VP group (19.8±6.3 N/mm) achieved the highest level of stiffness, and the other three groups did not differ significantly in terms of stiffness (2 K group, 5.4 ± 1.1 N/mm; DP group, 4.0 ± 0.9 N/mm; VP group, 3.9 ± 1.9 N/mm).
CONCLUSIONS
CONCLUSIONS
The fixation method involving the combined use of dorsal and volar locked plates (DP + VP group) resulted in optimal outcomes with respect to fixing metacarpal shaft fractures with volar wedge bone defects.
Identifiants
pubmed: 38702748
doi: 10.1186/s12891-024-07482-2
pii: 10.1186/s12891-024-07482-2
doi:
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
350Subventions
Organisme : China Medical University, Taiwan
ID : CMU111-MF-92
Informations de copyright
© 2024. The Author(s).
Références
Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am. 2006;31(7):e10681–9.
doi: 10.1016/j.jhsa.2006.06.006
Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. 2006;22(3):287–95.
doi: 10.1016/j.hcl.2006.02.018
pubmed: 16843795
Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal neck fractures: a review of surgical indications and techniques. Arch Trauma Res. 2016;5(3):e32933.
doi: 10.5812/atr.32933
pubmed: 27800460
pmcid: 5078834
Hussain MH, Ghaffar A, Choudry Q, Iqbal Z, Khan MN. Management of fifth metacarpal neck fracture (boxer’s fracture): a literature review. Cureus. 2020;12(7):e9442.
pubmed: 32864266
pmcid: 7451089
Sahu A, Gujral S, Batra S, Mills S, Srinivasan M. The current practice of the management of little finger metacarpal fractures—a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg. 2012;17(01):55–63.
doi: 10.1142/S0218810412500098
pubmed: 22351534
Orbay JL, Touhami A. The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails. Hand Clin. 2006;22(3):279–86.
doi: 10.1016/j.hcl.2006.02.017
pubmed: 16843794
Carlo Biz C, Iacobellis. Comparison of percutaneous intramedullary Kirschner wire and interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Acta Biomed. 2014;85(3):252–64.
pubmed: 25567462
Fusetti C, Meyer H, Borisch N, Stern R, Della Santa D, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma Acute Care Surg. 2002;52(3):535–9.
doi: 10.1097/00005373-200203000-00019
Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998;23(5):827–32.
doi: 10.1016/S0363-5023(98)80157-3
pubmed: 9763256
Dyrna FG, Avery DM, Yoshida R, Lam D, Oeckenpöhler S, Cote MP, et al. Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws. BMC Musculoskelet Disord. 2021;22(1):1–8.
doi: 10.1186/s12891-021-04200-0
Boussakri H, Elidrissi M, Azarkane M, Bensaad S, Bachiri M, Shimi M, et al. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases). Pan Afr Med J. 2014;18:187.
doi: 10.11604/pamj.2014.18.187.3347
pubmed: 25419314
pmcid: 4237565
Low C, Wong H, Low Y, Wong H. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Am. 1995;20(5):609–13.
doi: 10.1016/S0266-7681(05)80120-2
Pereira BP, Low CK, Ng RTH, Low YP, Wong HP. The effect of fracture malunion at the mid-shaft of the metacarpal on the extrinsic muscle forces. Clin Biomech. 1998;13(7):485–91.
doi: 10.1016/S0268-0033(98)00029-1
Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000;8(2):111–21.
doi: 10.5435/00124635-200003000-00005
pubmed: 10799096
Cha SM, Kang JW, Shin HD, Lee SH, Lee CW. Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length. Arch Orthop Trauma Surg. 2021;141(10):1815–23.
doi: 10.1007/s00402-021-03960-7
pubmed: 34009464
Balaram AK, Bednar MS. Complications after the fractures of metacarpal and phalanges. Hand Clin. 2010;26(2):169–77.
doi: 10.1016/j.hcl.2010.01.005
pubmed: 20494743
Izmalkov SN, Semenkin OM, Bratiichuk AN, Litvinov SA. Opening-wedge V-shaped corrective osteotomy for malunited fractures of metacarpal bones. J Orthop. 2020;19:208–11.
doi: 10.1016/j.jor.2019.10.013
pubmed: 32071515
Ring D. Malunion and nonunion of the metacarpals and phalanges. Instr Course Lect. 2006;55:121–8.
pubmed: 16958445
Barr C, Behn AW, Yao J. Plating of metacarpal fractures with locked or nonlocked screws, a biomechanical study: how many cortices are really necessary? Hand (N Y). 2013;8(4):454–9.
doi: 10.1007/s11552-013-9544-3
pubmed: 24426966
Chiu Y-C, Hsu C-E, Ho T-Y, Ting Y-N, Tsai M-T, Hsu J-T. Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture. J Orthop Surg Res. 2021;16(1):1–10.
doi: 10.1186/s13018-021-02575-3
Watt AJ, Ching RP, Huang JI. Biomechanical evaluation of metacarpal fracture fixation: application of a 90 degrees internal fixation model. Hand (N Y). 2015;10(1):94–9.
doi: 10.1007/s11552-014-9673-3
pubmed: 25767426
Yang C-Y, Liu T-Y, Hsu J-T, Tsai M-T. Biomechanical analysis of new cross locking plates for metacarpal neck fracture. J Med Biol Eng. 2022;42(4):404–13.
doi: 10.1007/s40846-022-00713-8
Doht S, Meffert RH, Raschke MJ, Blunk T, Ochman S. Biomechanical analysis of the efficacy of locking plates during cyclic loading in metacarpal fractures. ScientificWorldJournal. 2014;2014:648787.
doi: 10.1155/2014/648787
pubmed: 24757429
pmcid: 3976824
Malasitt P, Owen JR, Tremblay M-A, Wayne JS, Isaacs JE. Fixation for metacarpal neck fracture: a biomechanical study. Hand. 2015;10(3):438–43.
doi: 10.1007/s11552-015-9744-0
pubmed: 26330775
pmcid: 4551637
Ochman S, Vordemvenne T, Paletta J, Raschke MJ, Meffert RH, Doht S. Experimental fracture model versus osteotomy model in metacarpal bone plate fixation. ScientificWorldJournal. 2011;11:1692–8.
doi: 10.1100/2011/465371
pubmed: 22125428
pmcid: 3201679
Beaumont CM, Beason DP, McKeon KE. Fracture fixation strength in metacarpal plating versus intramedullary nailing using a 3-Point bending model: a cadaveric, biomechanical study. J Hand Surg Am. 2024;49(1):57. e1-57.e6.
doi: 10.1016/j.jhsa.2022.04.020
Liodaki E, Wendlandt R, Waizner K, Schopp BE, Mailander P, Stang F. A biomechanical analysis of plate fixation using unicortical and bicortical screws in transverse metacarpal fracture models subjected to 4-point bending and dynamical bending test. Med (Baltim). 2017;96(27):e6926.
doi: 10.1097/MD.0000000000006926
Maden M, Dulgeroglu AM, Bacaksiz T, Kazimoglu C. Does pin configuration matter in modified tension band wiring for transverse patellar fracture? A biomechanical study. Knee. 2022;39:300–7.
doi: 10.1016/j.knee.2022.09.014
pubmed: 36332559
Kim Y, Kwon M, Ryu JY, Moon SW. Biomechanical analysis of the Kirschner-Wire depth of the modified tension band wiring technique in transverse patellar fractures: an experimental study using the finite-element method. Clin Orthop Surg. 2021;13(3):315.
doi: 10.4055/cios20253
pubmed: 34484623
pmcid: 8380525
Gajendran VK, Szabo RM, Myo GK, Curtiss SB. Biomechanical comparison of double-row locking plates versus single-and double-row non-locking plates in a comminuted metacarpal fracture model. J Hand Surg Am. 2009;34(10):1851–8.
doi: 10.1016/j.jhsa.2009.07.005
pubmed: 19897325
Galbraith JG, Huntington LS, Borbas P, Ackland DC, Tham SK, Ek ET. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures. J Hand Surg Eur Vol. 2022;47(2):172–8.
doi: 10.1177/17531934211017705
pubmed: 34018870
Jones CM, Padegimas EM, Weikert N, Greulich S, Ilyas AM, Siegler S. Headless screw fixation of metacarpal neck fractures: a mechanical comparative analysis. Hand. 2019;14(2):187–92.
doi: 10.1177/1558944717731859
pubmed: 28933187