Metacarpal Fracture
Conditions
Keywords
Metacarpal Fracture, Intramedullary Fixation
Brief summary
Purpose: Intramedullary fixation has proven to be an efficacious intervention for metacarpal fractures. Advantages involve stable fixation facilitating early surgical rehabilitation and higher fracture union rates, without increased morbidity. We aimed to compare the results of fixation of metacarpal fractures with headless cannulated screws towards antegrade or retrograde on pain, function and quality of life in patients with metacarpal fractures. Methods: Patients admitted to Pamukkale University Orthopedics and Traumatology Department, due to metacarpal fracture were prospectively included in the study and randomly grouped. A total of 22 patients and 26 metacarpal fractures were assessed. Group I patients were operated with antegrade(proximal entry) , and group II with retrograde (distal entry) , using intramedullary headless cannulated screws. Appropriate screw selection was made by measuring the metacarpal isthmus diameter of the patient's x-ray results (AP and oblique direction). We used headless cannulated screws with diameters between 3.5mm and 5mm in the fractures.
Detailed description
This was a prospective randomised comparative single-blinded study comparing the effects of intramedullary fixation direction and entry site in patients with metacarpal fractures. The participants were first evaluated at post-operative 6th week and the last evaluation was performed at post-operative 12th week The evaluations included radiographic union, grip strength measurement (with Jamar hydraulic hand dynamometer), range of motion measurement (compared to the opposite hand), and Michigan Hand Outcome Questionnaire (MHQ) questionnaire. All assessments were performed by the same investigator. The researcher who performed the evaluations did not know which group the participants were in. In the antegrade headless cannulated screw fixation technique, a small incision was made on the extensor aspect of the fractured metacarpal at the level of the carpometacarpal (CMC) joint and the extensor tendon was excised. After fracture reduction, k-wire was inserted intramedullarly. After appropriate drilling, 1 headless cannulated screw was applied distally.(figure 1) In the fixation technique with retrograde headless cannulated screw, a small incision was made on the extensor side of the fractured metacarpal at the level of the MCP joint, and the extensor tendon split was passed. After fracture reduction, k-wire was inserted intramedullarly. After appropriate drilling, headless cannulated screw was applied proximally.
Interventions
PROCEDUREantegrade (proximal entry) fixation
In the antegrade headless cannulated screw fixation technique, a small incision was made on the extensor aspect of the fractured metacarpal at the level of the carpometacarpal joint.
PROCEDUREretrograde (distal entry) fixation
In the fixation technique with retrograde headless cannulated screw, a small incision was made on the extensor side of the fractured metacarpal at the level of the metacarpophalangeal joint.
Sponsors
Pamukkale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Operated for metacarpal fracture, * Speak and understand Turkish, * Understand the verbal and written information given. * Regular follow-up visits
Exclusion criteria
* Open epiphysis * Pathological fractures * Fractures requiring bone grafting
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Radiographic Examination (anteroposterior and oblique diameter) | postop 6th week | Primary bone healing was accepted as union when callus tissue developed in at least 3 cortices on AP and oblique radiographs taken with a radiography device or on the 6th week control radiograph. Radiological measurements were performed by a single observer. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Range of motion | postop 6th and 12th week | Range of motion was measured with a universal goniometer. All measurements were made with the patient in the sitting position. |
| Grip strength | postop 12th week | Grip strength was assessed as gross grip and pinch grip with a Jamar hand dynamometer and a pinchmeter according to the recommendation by the American Society of Hand Therapists. |
| Hand functionality (Michigan Hand Outcomes Questionnaire) | postop 12th week | Michigan Hand Outcomes Questionnaire consists of a total of 63 items for both hands and each item is scored between 1-5. It evaluates the hand and wrist in 6 domains: overall hand function, activities of daily living, pain, work performance, aesthetics, and patient satisfaction. |
Countries
Turkey (Türkiye)
Outcome results
None listed