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Comparative Study
. 2015 Aug;7(3):256-60.
doi: 10.1111/os.12195.

Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed K-Wires and Plate-Screw Constructs

Benjamin D Curtis  1 , Olukemi Fajolu  1 , Michael E Ruff  1 , Alan S Litsky  1
Affiliations
Comparative Study

Fixation of Metacarpal Shaft Fractures: Biomechanical Comparison of Intramedullary Nail Crossed K-Wires and Plate-Screw Constructs

Benjamin D Curtis et al. Orthop Surg. 2015 Aug.

Abstract

Objectives: Metacarpal (MC) fractures are very common, accounting for 18% of all fractures distal to the elbow. Many MC fractures can be treated non-operatively; however, some are treated most effectively with surgical stabilization, for which there are multiple methods. It was postulated that plates would have a significantly higher (P < 0.05) load to failure than crossed K(XK)-wires and that intramedullary metacarpal nails (IMNs) and XK-wires would have equivalent load to failure.

Methods: Mid-diaphyseal transverse fractures were created in 36 synthetic metacarpals and stabilized using nails, XK-wires or non-locking plates. Three-point bending was performed with continuous recording of load and displacement. Statistical analysis was performed using single factor ANOVA and Scheffe's test. Statistical significance was defined as P < 0.05.

Results: Biomechanical testing revealed significant differences between groups in load-to-failure. Average load to failure was significantly greater in the plate (1669 ± 322 N) than the XK-wire (146 ± 56 N) or IMN (110 ± 43 N) groups. The loads to failure of the K-wires and nails were equivalent. Plates were 11 and 15 times stronger in three-point bending than the K-wires and nails, respectively. There was no statistically significant difference between strengths of the K-wires and nails.

Conclusions: Although plates are the most stable means of fixation of midshaft metacarpal fractures, if minimally-invasive techniques are indicated, intramedullary nails may provide equivalent stability as commonly-used XK-wires. Although some studies have shown favorable clinical outcomes with IMNs, additional clinical correlation of these biomechanical results to fracture healing and outcomes is needed.

Keywords: Biomechanical; Intramedullary nail; Metacarpal fracture; Stabilization.

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Figures

Figure 1
Figure 1
Anteroposterior (A) and lateral (B) fluoroscopic views of an intramedullary nail in a composite metacarpal.
Figure 2
Figure 2
Servohydraulic test frame showing testing of IMN. The artificial bones are positioned palmar side up.
Figure 3
Figure 3
Load‐displacement curve for specimens stabilized with plates and screws.
Figure 4
Figure 4
Average load to failure (in Newtons).
See this image and copyright information in PMC

References

    1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am, 2001, 26: 908–915. - PubMed
    1. Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg, 2008, 16: 586–595. - PubMed
    1. Freeland AE, Geissler WB, Weiss AP. Surgical treatment of common displaced and unstable fractures of the hand. Instr Course Lect, 2002, 51: 185–201. - PubMed
    1. Strub B, Schindele S, Sonderegger J, Sproedt J, von Campe A, Gruenert JG. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur Vol, 2010, 35: 725–729. - PubMed
    1. Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K‐wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br, 2006, 31: 61–65. - PubMed

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