Management of paediatric fifth metacarpal neck fractures: a systematic review.

BACKGROUND: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. METHODS: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. RESULTS: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. CONCLUSIONS: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.

Ectrodactyly with Polydactyly in a Dog-Case Description and Description of Surgical Therapy with Resection and Fusion Podoplasty.

OBJECTIVE: To describe a rare congenital deformity of the phalanges and the surgical details and outcome in a dog with ectrodactyly combined with polydactyly. STUDY DESIGN: Single case report. ANIMAL: A 3.5-month-old male intact mixed breed dog with forelimb lameness and paw malformations. METHODS: Surgery was performed on a dog with a congenital limb deformity consisting of resection of the extra bone and soft tissue structure to prevent further subluxation of the remaining metacarpals. Stabilisation consisted of a cortical screw in compression and a K wire across the proximal metacarpals. RESULTS: Postoperative radiographs showed adequate implant positioning and good reduction of the proximal metacarpal row. At six weeks, the dog showed improvement in limb function and weight bearing. Major complications occurred at twelve weeks, and revision surgery with implant removal was required. At six months, the dog showed near normal range of motion and no lameness. CONCLUSIONS AND CLINICAL RELEVANCE: The decision to perform surgery on a dog with limb deformity resulted in an almost physiological gait, and the dog showed no abnormalities in daily life. This report adds to the literature on congenital limb deformities by describing the combination of ectrodactyly and polydactylism in a canine species, including the surgical approach and outcome. However, the optimal management of this heterogeneous condition is currently unclear.

Computer Assisted Bone Age Estimation Using Dimensions of Metacarpal Bones and Metacarpophalangeal Joints Based on Neural Network.

Statement of the Problem: Bone age is a more accurate assessment for biologic development than chronological age. The most common method for bone age estimation is using Pyle and Greulich Atlas. Today, computer-based techniques are becoming more favorable among investigators. However, the morphological features in Greulich and Pyle method are difficult to be converted into quantitative measures. During recent years, metacarpal bones and metacarpophalangeal joints dimensions were shown to be highly correlated with skeletal age. Purpose: In this study, we have evaluated the accuracy and reliability of a trained neural network for bone age estimation with quantitative and recently introduced related data, including chronological age, height, trunk height, weight, metacarpal bones, and metacarpophalangeal joints dimensions. Materials and Method: In this cross sectional retrospective study, aneural network, using MATLAB, was utilized to determine bone age by employing quantitative features for 304 subjects. To evaluate the accuracy of age estimation software, paired t-test, and inter-class correlation was used. Results: The difference between the mean bone ages determined by the radiologists and the mean bone ages assessed by the age estimation software was not significant (p Value= 0.119 in male subjects and p= 0.922 in female subjects). The results from the software and radiologists showed a strong correlation -ICC=0.990 in male subjects and ICC=0.986 in female subjects (p< 0.001). Conclusion: The results have shown an acceptable accuracy in bone age estimation with training neural network and using dimensions of bones and joints.

Stress Fracture of the Trapezoid in a Professional Tennis Player.

Background: Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and difficult to diagnose. To our knowledge, only 3 cases had been reported as of May 2023. We report the fourth case of a nontraumatic sports-related trapezoid stress fracture and only the second case in a tennis player. Case Report: A 29-year-old professional and right hand-dominant male tennis player presented with right hand and wrist pain for 3 weeks. He complained of dorsal wrist tenderness proximal to the base of the second metacarpal that was exacerbated by extension of the index finger. Initial radiographs were normal, but magnetic resonance imaging of the wrist showed a stress fracture of the trapezoid bone and base of the second metacarpal. The patient was treated conservatively with a wrist brace, cessation of sports activities, and modification of his training routine. The patient was asymptomatic at 1-year follow-up. Conclusion: This case highlights the relationship between trapezoid and second metacarpal stress fractures in athletes. A high index of suspicion for trapezoid stress fractures should be maintained and included in every differential diagnosis for athletes, especially racket sport players presenting with wrist pain. To avoid future injuries, clinicians should not only treat the fracture but also address the risk factors predisposing to this injury.

Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo / Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study

Introducción: La fractura de quinto metacarpiano es una dolencia muy frecuente que puede ocasionar deformidad y afectación funcional para la prensión adecuada de la mano. La reinserción a las actividades cotidianas o laborales se relaciona con el tratamiento recibido y la rehabilitación. En fracturas de cuello de quinto metacarpiano la fijación interna con aguja Kirschner es un método de tratamiento convencional con variantes que afectan su desenlace. Objetivo: Comparar los resultados funcionales y clínicos del tratamiento de las fracturas de quinto metacarpiano con el uso de agujas Kirschner vía retrógrada versus anterógrada. Material y métodos: Estudio comparativo, longitudinal, prospectivo, realizado en un hospital de tercer nivel de Traumatología, en pacientes con fractura de cuello de quinto metacarpiano, con seguimiento clínico, radiográfico y con escala Quick DASH a la tercera, sexta y octava semana postoperatoria. Resultados: Se incluyeron 60 pacientes (58 hombres, 2 mujeres), con un promedio de edad de 29,63±10,15 años, con fractura de quinto metacarpiano, tratados mediante reducción cerrada y estabilización con aguja Kirschner. La vía anterógrada mostró un rango de flexión metacarpofalángica a las 8 semanas de 89,11 grados (p<0,001; IC95% [−26.81; −11,42]), un valor de la escala DASH de 18,17 (p<0,001; IC95% [23,45; 39,12]) y un promedio de 27,35 días de incapacidad laboral (p=0,002; IC95% [16,22; 62,14]), comparada con la vía retrógrada. Conclusión: La estabilización con aguja Kirschner vía anterógrada mostró superioridad en resultados funcionales y en amplitud de movimiento metacarpofalángica comparados con los operados por vía retrógrada a la octava semana del postoperatorio.(AU)

Introduction: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the study: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methods: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. Results: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. Conclusion: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.(AU)

[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study / Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo

Introducción: La fractura de quinto metacarpiano es una dolencia muy frecuente que puede ocasionar deformidad y afectación funcional para la prensión adecuada de la mano. La reinserción a las actividades cotidianas o laborales se relaciona con el tratamiento recibido y la rehabilitación. En fracturas de cuello de quinto metacarpiano la fijación interna con aguja Kirschner es un método de tratamiento convencional con variantes que afectan su desenlace. Objetivo: Comparar los resultados funcionales y clínicos del tratamiento de las fracturas de quinto metacarpiano con el uso de agujas Kirschner vía retrógrada versus anterógrada. Material y métodos: Estudio comparativo, longitudinal, prospectivo, realizado en un hospital de tercer nivel de Traumatología, en pacientes con fractura de cuello de quinto metacarpiano, con seguimiento clínico, radiográfico y con escala Quick DASH a la tercera, sexta y octava semana postoperatoria. Resultados: Se incluyeron 60 pacientes (58 hombres, 2 mujeres), con un promedio de edad de 29,63±10,15 años, con fractura de quinto metacarpiano, tratados mediante reducción cerrada y estabilización con aguja Kirschner. La vía anterógrada mostró un rango de flexión metacarpofalángica a las 8 semanas de 89,11 grados (p<0,001; IC95% [−26.81; −11,42]), un valor de la escala DASH de 18,17 (p<0,001; IC95% [23,45; 39,12]) y un promedio de 27,35 días de incapacidad laboral (p=0,002; IC95% [16,22; 62,14]), comparada con la vía retrógrada. Conclusión: La estabilización con aguja Kirschner vía anterógrada mostró superioridad en resultados funcionales y en amplitud de movimiento metacarpofalángica comparados con los operados por vía retrógrada a la octava semana del postoperatorio.(AU)

Introduction: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the study: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methods: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. Results: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. Conclusion: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.(AU)

[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study.

INTRODUCTION: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde vs. antegrade Kirschner wires. MATERIAL AND METHODS: Comparative, longitudinal, prospective study at a third-level trauma centre in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilisation with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION: Stabilisation with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study. / Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo.

INTRODUCTION: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. AIM OF THE STUDY: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. MATERIAL AND METHODS: Comparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. RESULTS: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. CONCLUSION: Stabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) in the Hand: A Case Report and a Review of the Literature.

A Nora's lesion, a rare and typically non-cancerous growth originating from the parosteal osteochondromatous tissue, primarily manifests in the hands and feet. Despite its benign nature, diagnosing Nora's lesions is complex due to their tendency to exhibit aggressive features in imaging scans and the ambiguity encountered in histological examinations. This rarity is evidenced by the limited number of reported cases in medical literature since its initial discovery. Detailing a distinctive instance, we document a specific case of a Nora's lesion situated on the dorsum of the left hand, specifically above the shafts of the fourth and fifth metacarpal bones. Through a meticulous histopathological analysis, the diagnosis was confirmed, aligning precisely with imaging features. To address the lesion conclusively, a comprehensive surgical excision of the mass was performed. This particular case not only adds to the scant body of documented instances but also underscores the significance of accurate diagnosis and management. Understanding and documenting such cases are crucial in refining diagnostic approaches and optimizing treatment strategies for Nora's lesions, emphasizing the ongoing need for further research in this domain.

Biomechanical analysis of locking plates for fixation of metacarpal shaft fractures: A finite element analysis.

BACKGROUND: There appears to be a paucity of knowledge about the biomechanics of locking plates for the fixation of metacarpal shaft fractures. A thorough understanding of the biomechanics of locking plates is needed to apply them correctly, optimize outcomes, and avoid complications. The purpose of this study is to investigate the biomechanics of the fixation of metacarpal fractures using locking plate-screw constructs with different numbers of screws. HYPOTHESIS: The difference in the number of screws in the locking plate influenced the biomechanical outcome of the metacarpal fracture. METHODS: Finite element models of third metacarpal fractures with locking plate-screw constructs were established, and the magnitude and distribution of their stresses and displacements were investigated when a vertical load of 100N was applied. RESULTS: For the metacarpal fracture with a locking plate and screws, the stress in the metacarpal was largely shared by the plate-screw construct. For the plate-screw construct, the stress is concentrated in the area close to the fracture line, and the 6-screw Group has the lowest failure risk since it has the lowest plate stress and the second-lowest screw stress. The implant-bone construct with 8 screws has better biomechanical stability because of minimal displacement, but increased stress on both the metacarpal bone and the screws, leading to increased failure rates. DISCUSSION: The stresses in the metacarpal were mostly shared by the plate-screw constructs and the screws closest to the fracture line were the most likely to break or loosen. For the implant-bone constructs, the locking plate with 2 screws was the most vulnerable to break or loosen, whereas the locking plate with 6 screws was the least likely to break or loosen. The implant-bone construct with 8 screws had better biomechanical stability, but the stresses in both the metacarpal and the screws were increased, which increased the risk of failure. LEVEL OF EVIDENCE: IV, basic science study.

Dorsal Approach in the Surgical Treatment of Complex Dorsal Dislocation of Index Metacarpophalangeal Joint; a Case Report.

Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. This study describes a right-handed 14-year-old boy who fell on the outstretched hand and sustained a dorsal dislocation of the left index MCP joint. The dislocation was complicated by an epiphyseal metacarpal head fracture with dorsal-ulnar displacement of the osteochondral fragment. The patient underwent open reduction through the dorsal approach, and the metacarpal head was fixed via the two-screw technique. The patient resumed left-hand function after six weeks. At the two-year follow-up, the range of motion and grip strength were normal, the patient was pain-free, and no sign of growth disturbance or joint stiffness was detected. Dorsal surgical approach with screw fixation is a feasible technique for the treatment of complex MCP dislocation, especially when it is complicated by a large epiphyseal head fracture.

Detection of turner syndrome using hand X-ray using anchor based links segmentation method.

Turner Syndrome (TS) is a chromosomal disorder, wherein the female's growth is impacted. Immature ovaries, low stature, and heart abnormalities are a range of developmental and medical issues due to TS. The condition of TS might be detected prior to birth, throughout infancy or in the early years of life. The diagnosis of TS in girls with modest symptoms and indications is sometimes deferred until they reach adolescence or become young adults. This study presents an algorithm to segment the hand digital X-ray image in children with TS. In medical image and computer vision examination, image segmentation is demanding, and very crucial. Prevailing segmentation algorithms even now suffer from common segmentation issues including under-segmentation, over-segmentation, and spurious or non-closed edges, regardless of the several years of studies. In this paper, Anchor Based Link (ABL) segmentation approach is proposed to detect TS based on fourth Metacarpal bone from left hand X-ray images. The detection of TS is demonstrated based upon the comparison of proposed approach with existing watershed segmentation and Gaussian-Mixture-Model-based Hidden-Markov-Random-Field (GMM-HMRF) method. The proposed approach attains better segmentation based on the ratio of height and width of left fourth finger that is analyzed for normal children and children having TS with the help of edge pixel present in the metacarpal bone that has been segmented. The suggested method is verified on fifty (50) sample X-ray hand images of carpal bones, providing 0.60 ± 0.02 as an average Dice coefficient.

Palmar approach for fixation of metacarpal fractures.

Between 2018 and 2020, 14 patients with closed metacarpal fractures requiring open reduction were operated on via a palmar approach. Reduction and fixation were done with screws or plates. We assessed range of motion, grip strength, Mayo score, possible nerve damage and cosmesis. The range of motion and grip strength were fully restored by 6 months after operation. Transient paraesthesiae in the digital nerve territory occurred in two patients and had resolved by 3 months. In selected patients the palmar approach for metacarpal shaft fractures can provide satisfactory cosmesis and function of the hand. This method can be useful in patients with history of hypertrophic scarring or in patients who would prefer to avoid a visible scar on the dorsum of the hand.Level of evidence: IV.

Management of extra-articular shaft fractures of the non-thumb metacarpals: plate-screw fixation versus K-wire fixation.

Metacarpal fractures are common injuries and comprise nearly 36% to 42% of all fractures in the hand. The majority of these can be managed non-surgically. Operative fixation when needed, can be done by a variety of techniques. In this study, we have compared the outcomes of two techniques, plate-screw fixation and K-wire fixation. We have conducted a prospective, non-randomized, comparative study of patients who presented with extra-articular metacarpal shaft fractures of non-thumb metacarpals over a period of 18 months. 30 patients were enrolled according to the inclusion criteria and were alternately allotted to the plate-screw group and the K-wire group. At admission, patient demographics, clinical features, number of fractures, and fracture patterns were recorded, and radiographs were taken. In the plate-screw group, low-profile plates and screws were used, and in the K-wire group, 1 or 2 K-wires were used for fixation after fracture reduction. Hand mobilization exercises were started within one week in the plate-screw group, while in the K-wire group full mobilization was allowed at 4 weeks post-surgery. The Disabilities of Arm, Shoulder and Hand (DASH) score was calculated and compared between the two groups at 6 months and 12 months after surgery. The mean 6-month DASH score in the plate-screw group was 6.3287±2.2453, while it was 17.1627±6.2103 in the K-wire group (p value <0.001). At the end of 1-year follow-up, the mean DASH score in the plate-screw group was 5.1080±1.6637, and in the K-wire group, it was 5.1073±1.9392 (p value =0.848). In conclusion, extra-articular metacarpal shaft fractures of the non-thumb metacarpals treated by plate-screw fixation had significantly better DASH scores and hence better functional outcomes at the end of 6 months. However, at the end of 1 year, the DASH scores in both the groups were almost similar, suggesting similar functional outcomes in the long term.

Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study.

Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws ( n = 20) or bouquet (2 or 3 Kirschner wires) ( n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study / Fixação intramedular com parafusos de compressão versus técnica do buquê em fraturas instáveis do colo do metacarpo em pacientes ativos: Ensaio clínico randomizado

Abstract Objeticve To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer's fractures, operated in the first week. Methods This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months. Results At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group. Conclusions In the treatment of the active patients with unstable boxer's fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Resumo Objetivo Comparar a amplitude de movimento (ADM), o tempo de retorno de trabalho, a pontuação na escala visual analógica (EVA), o escore no questionário abreviado incapacidade do braço, ombro e mão (QuickDASH, na sigla em inglês) e os resultados radiográficos de dois métodos de fixação interna definitiva em pacientes ativos com fraturas do boxer; operados na primeira semana. Métodos Este foi um ensaio prospectivo randomizado, no qual 50 pacientes, com idade mediana na faixa de 18 a 40 anos, foram randomizados e tratados com fixação intramedular definitiva utilizando 2 parafusos de compressão (n = 20) ou buquê (2 ou 3 fios de Kirschner) (n = 20). Os pacientes foram avaliados em relação ao tempo de retorno ao trabalho, à ADM, ao desfecho relatado pelo paciente no questionário QuickDASH, à EVA e à avaliação radiográfica aos 6 meses. Resultados Aos 6 meses, não houve diferenças entre os 2 grupos em termos de ADM, dor pós-operatória (EVA) ou escore no QuickDASH. A taxa global de complicações foi de 4,76% no grupo de fixação com parafusos, em comparação com 5% no grupo de fixação com a técnica do buquê. Conclusões Parafusos de compressão e fixação com buquês provaram ser tratamentos seguros e confiáveis para pacientes ativos com fraturas instáveis. Os resultados foram semelhantes nos dois grupos.

Current Opinions on the Management of Non Thumb Metacarpal Fractures.

Metacarpals are unique bones that support the finger to aid hand function. Metacarpals are also the commonest bones to get fractured in the hand. Historically, most metacarpal fractures were managed conservatively. Due to increased patient expectations as well as advancements in diagnosis and osteosynthesis, various surgical options are now available for metacarpal fractures. The goal of operative management of metacarpal management is no longer limited to achieving clinical or radiological union. To restore hand function to a preinjury level, the surgeon must achieve adequate anatomical reduction and stable fixation with minimal soft tissue damage. Similar to tendon repair, to start early active motion should be the goal after metacarpal fracture fixation. Intraoperative consideration should also include minimizing soft tissue damage and avoiding tendon, ligament or capsular entrapment. The aim of this article is to explain the principles of surgical management, the different options available for metacarpal fractures, the techniques, pearls, advantages and disadvantages of each technique, so the surgeon can choose the ideal option to achieve the best result.

Dorso-palmar elongation of the diaphysis of the third metacarpal bone in prehistoric Jomon people.

This study investigated cross-sectional morphological differences in the diaphysis of the third metacarpal bone (MC3) between prehistoric Jomon hunter-gatherers and modern Japanese people. Overall, 179 skeletal remains of 119 individuals (73 men and 46 women) from the Middle-to-Final Jomon period (3500 BC-500 BC) and 60 modern Japanese people (35 men and 25 women) were included in the analysis. Analyses were performed at the mid-shaft of the MC3 using linear measurement, elliptic Fourier analysis, and cross-sectional geometric properties. The standardized polar section modulus (ZpSTD) indicated sexual differences in both populations. The right MC3 was generally stronger than the left side. There was no populational difference in the ZpSTD in both sexes. In both men and women, the cross-sectional shape of the MC3 was relatively larger in the dorso-palmar direction than in the radioulnar direction in the Jomon population compared to the modern Japanese population. Sexual differences in cross-sectional shape were recognized only in the Jomon population, with the dorso-palmar elongation being greater in Jomon men than in women (particularly when comparing the left MC3). There was a significant side difference in the diaphyseal shape among Jomon women, with the right MC3 being relatively larger in the dorso-palmar direction. These findings were consistent, although skeletal remains of the Jomon population were excavated from different regions. Differences in the diaphyseal cross-sectional shape between populations suggest differences in habitual loading on MC3 associated with differences in subsistence behavior. Furthermore, differences in diaphyseal shape and strength between Jomon men and women suggest sexual division of labor, with men performing bimanual tasks and women performing unimanual tasks.

Reconstruction of composite bone and soft tissue defect of the hand or foot with the chimeric medial femoral condyle osteofascial free flap / 中华显微外科杂志

Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.

[Revision surgery after resection arthroplasty of the thumb saddle joint]. / Revisionsoperationen nach Resektionsarthroplastiken am Daumensattelgelenk.

BACKGROUND: Resection arthroplasty still is the gold standard for the treatment of basal thumb arthritis. In most patients, satisfactory results can be expected. However, the few patients with persisting problems are a challenge for the hand surgeon. They may complain of neuromas, tendinitis of the flexor carpi radialis (FCR) tendon, impingement and/or proximalization of the first metacarpal, arthritis of the scaphotrapezoidal joint or carpal collapse in the case of pre-existing scapholunate instability. DIAGNOSIS: This includes subtle clinical examination. Radiography may be completed by a CT scan. Probational infiltration is a helpful tool to confirm diagnosis and may be the first step of a conservative treatment, when supplemented by orthoses. TREATMENT: Revision surgery is guided by the nature of the present problem. Neurolysis should be indicated cautiously and performed according to existing principles. FCR tendinitis is treated by release or resection of the tendon. Impingement of the first metacarpal is treated by repeat resection and tendon interposition, proximalization by additional suspension arthroplasty or by arthrodesis between the bases of the first and second metacarpals. In the case of scaphotrapezoidal arthritis, the proximal third of the trapezoid is resected, whereas destabilization of the scaphoid with consecutive carpal collapse may necessitate midcarpal fusion.