Details
Category: Volume 07 Issue 02 February 2019
Hits: 1281

Title: Evaluation of AO Titanium Locking Plate and Screw Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures

Authors: Dr M.Chandrashekar, Dr.M.Sudhir

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.35

Abstract

Arbeitsgemeinschaft-osteosynthesefragen (AO) mini-fragment screws and plates, when used in properly selected cases, can provide rigid fixation, allowing early mobilization of joints and hence good functional results while avoiding problems associated with protruding K-wires and immobilization. This study was conducted at government medical college after getting permission from hospital ethics committee, includes 30 patients of which 20 were males and 10 were females. The average age was 30.4 years. Twenty fractures were fixed with miniature plates and 10 with interfragmentary lag screws. The right hand was involved in 22 cases. There were 15 metacarpal, 9 proximal phalangeal, and 6 middle phalangeal fractures. The distribution of the above fractures was as follows: thumb ray 7, index ray 9, middle ray 3, ring ray 6, and little ray 5. Mechanism of injury included fall(11), direct blow(3) and traffic accident(16).There were transverse(7), oblique(11), spiral(6), intraarticular(4), and 2 were comminuted. All the fractures were closed. These patients were evaluated post operatively for 3,6 months and one year.  All of them presented improvement in their clinical and functional parameters regarding the variables of range of motion (ROM), visual analog scale (VAS) score, Grip  strength value(%) and DASH (Disability of the Arm, Shoulder and Hand) score. All the patients achieved improved quality of life and returned to work, with significant decreases in their DASH questionnaire scores (14-2). There was an improvement in pain, with decreases in their VAS scores (2-0). This technique provides a highly rigid fixation, which is sufficient to allow early mobilization of the adjacent joints, thus helping to achieve good functional results.

Keywords: AO Screws and plates, unstable, metacarpal, phalangyeal, fracutes and fixation.

References

  1. Henry MH. Fractures and dislocations in the hand. In: Bucholz RW, Beckman JD, Court-Brown CM, eds. Rockwoodand Green’s Fractures in Adults. Vol. 1, 6th edn. New York: Lippincott, 2006; 772–855.
  2. Zhang Y. Clinical Epidemiology of Orthopedic Trauma. Stuttgart & New York: Thieme, 2012.
  3. Kenji Kawamura, MD, Kevin C. Chung, MD, MS*Fixation Choices for Closed Simple Unstable Oblique halangeal and Metacarpal Fractures .Hand Clin 22 (2006) 287–295
  4. Crawford GP. Screw fixation for certain fractures of the phalanges and metacarpals. J Bone Joint Surg Am 1976;58:487-92.
  5. Ford DJ, el-Hadidi S, Lunn PG, Burke FD. Fractures of the metacarpals: treatment by A. O. screw and plate fixation. JHand Surg Br 1987;12:34-7.
  6. Dabezies EJ, Schutte JP. Fixation of metacarpal and phalangeal fractures with miniature plates and screws. J Hand Surg Am 1986;11:283-8.
  7. Chung KC. Evaluation of preoperative expectations and patient satisfaction after carpal tunnel release. J Hand Surg Am, 2008, 33: 1789–1790.
  8. Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Arch Phys Med Rehabil, 1991, 72: 280–283.
  9. Lamraski G, Monsaert A, De Maeseneer M, Haentjens P. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res, 2006,24:37–45.
  10. Lee SK, Kim KJ, Choy WS. Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures. Eur J Orthop Surg Traumatol, 2013, 23: 535–543.
  11. Doht S, Jansen H, Meffert R, Frey S. Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model. Int Orthop, 2012, 36: 1641–1646.
  12. Margic K. External fixation of closed metacarpal and phalangeal fractures of digits. A prospective study of one hundred consecutive patients. J Hand Surg Br, 2006, 31: 30–40.
  13. Omokawa S, Fujitani R, Dohi Y, Okawa T, Yajima H. Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system. J Hand Surg Am, 2008, 33: 857–863.
  14. Trevisan C, Morganti A, Casiraghi A, Marinoni EC. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch OrthopTrauma Surg, 2004, 124: 675–680.
  15. Fyfe IS, Mason S. The mechanical stability of internal fixation of fractured phalanges. Hand 1979;11:50-4.
  16. Black D, Mann RJ, Constine R, Daniels AU. Comparison ofinternal fixation techniques in metacarpal fractures. J Hand Surg Am 1985;10:466-72.
  17. Agarwal AK, Pickford MA. Experience with a new ultralowprofile osteosynthesis system for fractures of the metacarpalsand phalanges. Ann Plast Surg 2006;57:206-12.
  18. Bing Zhang, Pan Hu, Kun-lun Yu, Jiang-bo Bai,  De-hu Tian, MD, Gui-sheng Zhang, Xin-zhong Shao,  Ying-ze Zhang. Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures. Orthopaedic Surgery 2016;8:316–322 • DOI: 10.1111/os.12271.
  19. Fujitani R, Omokawa S, Shigematsu K, Tanaka Y. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures.J Orthop Sci, 2012, 17: 450–456.
  20. Ozer K, Gillani S, Williams A, Peterson SL, Morgan S. Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures. J Hand Surg Am, 2008, 33: 1724–1731.
  21. Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpalneck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res, 2010, 96: 506–512.
  22. Westbrook AP, Davis TR, Armstrong D, Burke FD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol, 2008, 33: 732–739.
  23. Souer JS, Mudgal CS. Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand Surg Eur Vol, 2008, 33: 740–744.

Corresponding Author

Dr M. Sudhir

Assistant Professor, Department of Orthopaedics, Kamineni Academy of Medical Sciences and Research Centre, LB Nagar, Hyderabad

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no: 8897969381