Abstract
Purpose
Complications in metacarpal fracture treatment increase in proportion to the severity of the initial injury and the invasiveness of the surgical fixation technique. This manuscript evaluates the feasibility of minimizing internal fixation construct size and soft tissue dissection, while preserving the advantages of stable internal fixation in a biomechanical model. We hypothesized that comparable construct stability could be achieved with mini-plates in an orthogonal (90/90) configuration compared with a standard dorsal plating technique.
Methods
This hypothesis was evaluated in a transverse metacarpal fracture model. Twelve metacarpals were subject to either placement of a 2.0-mm six-hole dorsal plate or two 1.5-mm four-hole mini-plates in a 90/90 configuration. These constructs were tested to failure in a three-point bending apparatus, attaining failure force, displacement, and stiffness.
Results
Mean failure force was 353.5 ± 121.1 N for the dorsal plating construct and 358.8 ± 77.1 N for the orthogonal construct. Mean failure displacement was 3.3 ± 1.2 mm for the dorsal plating construct and 4.1 ± 0.9 mm for the orthogonal construct. Mean stiffness was 161.3 ± 50.0 N/mm for the dorsal plating construct and 122.1 ± 46.6 N/mm for the orthogonal construct. Mean failure moment was 3.09 ± 1.06 Nm for the dorsal plating construct and 3.14 ± 0.67 Nm for the orthogonal construct. The dorsal plating group failed via screw pullout, whereas the orthogonal failed either by screw pullout or breakage of the plate.
Conclusions
When subject to apex dorsal bending, the orthogonal construct and the standard dorsal plate construct behaved comparably. These data suggest that despite its shorter length, lower profile, and less substantial screws, the orthogonal construct provides sufficient rigidity.
Clinical Relevance
This study represents a “proof of concept” regarding the applicability of orthogonal plating in the metacarpal and provides the foundation for minimizing construct size and profile.
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References
Bach HG, Gonzalez MH, Hall Jr RF. Locked intramedullary nailing of metacarpal fractures secondary to gunshot wounds. J Hand Surg. 2006;31A:1083–7.
Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg. 2001;26A:908–15.
Dabezies EJ, Schutte JP. Fixation of metacarpal and phalangeal fractures with miniature plates and screws. J Hand Surg. 1986;11A:283–8.
Dona E, Gillie RM, Gianoutsos MP, Walsh WR. Plating of metacarpal fractures: unicortical or bicortical screws? J Hand Surg. 2004;29B:218–21.
Fambrough RA, Green DP. Tendon rupture as a complication of screw fixation in fractures in the hand: a case report. J Bone Joint Surg. 1979;61A:781–2.
Firoozbakhsh KK, Moneim MS, Howey T, Castaneda E, Pirela-Cruz MA. Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques. J Hand Surg. 1993;18A:1059–68.
Fischer KJ, Bastidas JA, Provenzano DA, Tomaino MM. Low-profile versus conventional metacarpal plating systems: a comparison of construct stiffness and strength. J Hand Surg. 1999;24A:928–34.
Ford DJ, el-Hadidi S, Lunn PG, Burke FD. Fractures of the metacarpals: treatment by AO screw and plate fixation. J Hand Surg. 1987; 12B: 34–37
Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res. 2006;445:133–45.
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. 2009;34A:1851–8.
Gonzalez MH, Ingram CM, Hall Jr RF. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg. 1995;20A:382–7.
Green A. Open reduction and internal fixation with 90-90 plating of bicolumn distal humerus fractures. Instr Course Lectures. 2009;58:515–9.
Helmerhorst GT, Kloen P. Orthogonal plating of intra-articular distal radius fractures with an associated radial column fracture via a single volar approach. Injury. 2012;43(8):1307–12.
Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. 2006;22:287–95.
Kozin SH, THoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000;8:111–21.
Orbay J. Intramedullary nailing of metacarpal shaft fractures. Tech Hand Up Extrem Surg. 2005;9:69–73.
Ozer K, Gillani S, Williams A, Peterson SL, Morgan S. Comparison of intramedullary nailing versus plate and screw fixation of extra-articular metacarpal fractures. J Hand Surg. 2008;33A:1724–31.
Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg. 1998;23A:827–32.
Prevel CD, McCarty M, Katona T, Moore K, Jackson JR, Eppley BL, et al. Comparative biomechanical stability of titanium bone fixation systems in metacarpal fractures. Ann Plast Surg. 1995;35:6–14.
Shin SJ, Sohn HS, Do NH. A clinical comparison of two different double plating methods for intra-articular distal humerus fractures. J Shoulder Elbow Surg. 2010;19(1):2–9.
Sletten IN, Nordsletten L, Husby T, Odegaard RA, Hellund JC, Kvernmo HD. Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. J Hand Surg (Eur). 2012;37:387–95.
Sohn RC, Jahng KH, Curtiss AS, Szabo RM. Comparison of metacarpal plating methods. J Hand Surg. 2008;33A:316–21.
Stern PJ, Wieser MJ, Reilly DG. Complications of plate fixation in the hand skeleton. Clin Orthop Relat Res. 1987;214:59–65.
Vanik RK, Weber RC, Matloub HS, Sanger JR, Gingrass RP. The comparative strengths of internal fixation techniques. J Hand Surg. 1984;9A:216–21.
Vennetilli M, Athwal GS. Parallel versus orthogonal plating for distal humerus fractures. J Hand Surg. 2012;37A:819–20.
Waris E, Ashammakhi N, Raatikainen T, Tormala P, Santavirta S, Konttinen YT. Self-reinforced bioabsorbable versus metallic fixation systems for metacarpal and phalangeal fractures: a biomechanical study. J Hand Surg. 2002;27A:902–9.
Zalavras CG, Vercillo MT, Jun BJ, Otarodifard K, Itamura JM, Lee TQ. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg. 2011;20(1):12–20.
Conflict of Interest
Andrew J. Watt, Randal P. Ching, and Jerry I. Huang have no personal relationship or financial interests to disclose.
Statement of Human and Animal Rights
This study was conducted with approval from the Institutional Review Board. All tissues were treated and handled in accordance with Institutional Review Board recommendations for the handling of cadaveric subjects.
Statement of Informed Consent
This study is a biomechanical, cadaveric study; therefore, no informed consent was obtained. All tissues were treated and handled in accordance with Institutional Review Board recommendations for the handling of cadaveric subjects.
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Watt, A.J., Ching, R.P. & Huang, J.I. Biomechanical evaluation of metacarpal fracture fixation: application of a 90° internal fixation model. HAND 10, 94–99 (2015). https://doi.org/10.1007/s11552-014-9673-3
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DOI: https://doi.org/10.1007/s11552-014-9673-3