Current Concepts in Managing Fractures of Metacarpal and Phalangess Review Article
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Treatment of Comminuted Fractures of the Base of the Thumb Metacarpal Using a Cemented Bone-K-Wire Frame
Hand Surgery and Rehabilitation 38 (2019) 44–51 Available online at ScienceDirect www.sciencedirect.com Original article Treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame Traitement des fractures comminutives de la base du premier me´tacarpien graˆce a` un cadre os-broches-ciment W. Duan, X. Zhang, Y. Yu, Z. Zhang *, X. Shao, W. Du Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, PR China ARTICLE INFO ABSTRACT Article history: We aimed to describe the treatment of comminuted fractures of the base of the thumb metacarpal using a Received 13 June 2018 cemented bone-K-wire frame. Between March 2010 and January 2016, 41 fractures of the base of the thumb Received in revised form 8 August 2018 were treated using a cemented bone-K-wire frame. The mean age of the patients was 34 years. The patients’ Accepted 7 September 2018 history included a fall onto the hand in 7 cases, direct trauma in 31 cases, and polytrauma with an unclear Available online 11 October 2018 mechanism of injury in 3 cases. At the final follow-up, hand grip and pinch strength were measured using a dynamometer. All measurements were compared with those of the opposite hand. The patients were assessed Keywords: functionally using the Smith and Cooney score.All K-wires were left in place until the bone healed. Bone healing Cemented K-wire frame was achieved in all thumbs in an average of 5.2 weeks. Follow-up averaged 27 months. The mean hand pinch External fixator Rolando fracture andgripstrengthwas8.7 kg Æ 2.4 kgand38.4 kg Æ 5.9 kg,respectively.Themeanmeasurementsontheopposite Thumb side were 9.2 kg Æ 2.5 kg and 40.2 kg Æ 6.6 kg, respectively. -
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis Authors: JJ Vaux OMS-IV1, RR Hugate, M.D.2, JW Hills3, RF Grzybowski, D.O.4, CK Funk. Ph.D.1 Affiliations: 1Rocky Vista University College of Osteopathic Medicine, 2Colorado Limb Consultants, 3Dept of Materials and Mechanical Engineering, Denver University, 4Diversified Radiology Objective: Amputation of the thumb presents a serious insult to the hand and can result in up to a 22% loss of functionality in that limb (2,3). To date, several different techniques have been explored for reconstruction of the thumb, however none seem to be incredibly successful (1,4). We believe the answer lies in an osseointegrated prosthesis within the first metacarpal. In order to successfully create an osseointegrated prosthesis, the morphometrics of the first metacarpal are needed. The aim of this study was to define the geometry of the first metacarpal in order to help create a standardized set of stems and prostheses to treat patients who have suffered amputation of the thumb at the level of the first metacarpal phalangeal joint (MCPJ). Methods: A total of eighty first metacarpals from forty-one cadavers were studied. All soft tissues were removed and the first metacarpals were imaged by computed tomography (CT). Three-dimensional models were constructed using cuts from the coronal, sagittal, and axial planes. Using a HyperMesh software, the individual first metacarpals were analyzed and measurements were taken for overall length, radius of curvature, medullary canal diameter, cortical thickness, and distance from the distal end to the center of the isthmus. -
Approach to Hand Conditions
Approach to Hand Conditions Alphonsus Chong Associate Professor, Department of Orthopaedic Surgery, Singapore Senior Consultant, Department of Hand and Reconstructive Microsurgery, Singapore http://bit.ly/39fuCIK [email protected] Scope • Introduction – Slides at http://bit.ly/39fuCIK • And other material at: https://nus.edu/2Mh4e4s • Physical examination http://bit.ly/39fuCIK : these slides • Traumatic injuries – open and closed • Peripheral nerve problems • Masses in the hand and wrist • Tendinopathy and tendinitis • Deformity https://nus.edu/2Mh4e4s: hand wiki 3 History Taking • Pain – different aspects • Handedness • Deformity • Job v – Congenital • Hobbies – Acquired - ? Traumatic • Previous injury/ surgery • Decreased rangev of motion • Weakness • For acute trauma/conditions: • Numbness – Last meal v • Others e.g. triggering, instability – Mechanism of injury – Time/date of injury Expose both sides: subcutaneous border Scars, wasting, deformity of ulna and elbow- rheumatoid nodules Completeness and fluidity of motion Scars, wasting, deformity Quick Nerve Screen Median Nerve Radial Nerve Ulnar nerve Traumatic Injuries – Open Injuries Open traumatic injuries are a staple work of hand surgeons. Assessment of Hand – Work through the tissues (see Apley) • Skin – note size and types of wounds • Vessels - circulation • Nerves – sensation and motor • Muscle and Tendons – individual flexor and extensor tendon testing • Bones & Joints – appropriate x-rays to assess fractures/ dislocation What do you see? • LOOK • LOOK – Loss of cascade • -
The Carpometacarpal Joint of the Thumb: MR Appearance in Asymptomatic Volunteers
Skeletal Radiol (2013) 42:1105–1112 DOI 10.1007/s00256-013-1633-4 SCIENTIFIC ARTICLE The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers Anna Hirschmann & Reto Sutter & Andreas Schweizer & Christian W. A. Pfirrmann Received: 23 January 2013 /Revised: 1 April 2013 /Accepted: 21 April 2013 /Published online: 15 May 2013 # ISS 2013 Abstract subjects. The AOL showed a variable SI (36 %/42 % low, Purpose To prospectively characterize the MR appearance 27 %/27 % increased, 36 %/30 % striated). The IML was the of the carpometacarpal (CMC) joint of the thumb in asymp- thickest ligament with a mean of 2.9 mm/3.1 mm and the tomatic volunteers. DRL the thinnest (1.2 mm/1.4 mm). There was a mean Materials and methods Thirty-four asymptomatic volun- dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation teers (17 women, 17 men, mean age, 33.9±9.2 years) of 2.8 mm/3.4 mm of the metacarpal base. The AOL was underwent MR imaging of the thumb after approval by the significantly thicker in men (1.7 mm) than in women local ethical committee. Two musculoskeletal radiologists (1.2 mm; p=0.02). Radial subluxation was significantly independently classified visibility and signal intensity (SI) larger in men (3.4 mm) than in women (2.2 mm; p=0.02). characteristics of the anterior oblique (AOL/beak ligament), No subluxation in palmar or ulnar direction was seen. the posterior oblique (POL), the intermetacarpal (IML), and Conclusions Radial and dorsal subluxation of the CMC the dorsoradial ligaments (DRL) on a three-point Likert joint can be a normal finding in a resting position at MR scale. -
Listen to the Associated Podcast Episodes: MSK: Fractures for the ABR Core Exam Parts 1-3, Available at Theradiologyreview.Com O
MSK: Fractures for Radiology Board Study, Matt Covington, MD Listen to the associated podcast episodes: MSK: Fractures for the ABR Core Exam Parts 1-3, available Listen to associated Podcast episodes: ABR Core Exam, Multisystemic Diseases Parts 1-3, available at at theradiologyreview.com or on your favorite podcast directory. Copyrighted. theradiologyreview.com or on your favorite podcast direcry. Fracture resulting From abnormal stress on normal bone = stress Fracture Fracture From normal stress on abnormal bone = insuFFiciency Fracture Scaphoid Fracture site with highest risk for avascular necrosis (proximal or distal)? Proximal pole scaphoid Fractures are at highest risk For AVN Comminuted Fracture at the base oF the First metacarpal = Rolando Fracture Non-comminuted Fracture at base oF the First metacarpal = Bennett Fracture The pull oF which tendon causes the dorsolateral dislocation in a Bennett fracture? The abductor pollicus longus tendon. Avulsion Fracture at the base oF the proximal phalanx with ulnar collateral ligament disruption = Gamekeeper’s thumb. Same Fracture but adductor tendon becomes caught in torn edge oF the ulnar collateral ligament? Stener’s lesion. IF Stener’s lesion is present this won’t heal on its own so you need surgery. You shouldn’t image a Gamekeeper’s thumb with stress views because you can convert it to a Stener’s lesion. Image with MRI instead. Distal radial Fracture with dorsal angulation = Colle’s Fracture (C to D= Colle’s is Dorsal) Distal radial Fracture with volar angulation = Smith’s Fracture (S -
Metacarpal Fractures
METACARPAL FRACTURES BY LORYN P. WEINSTEIN, MD, AND DOUGLAS P. HANEL, MD The majority of metacarpal fractures are closed injuries amenable to conservative treatment with external immobilization and subsequent rehabilitation. Internal fixation is favored for unstable fracture patterns and patients who require early motion. Percutaneous pinning usually is successful for metacarpal neck fractures and comminuted head fractures. Shaft and base fractures can be treated with pinning or open reduction and internal fixation; the latter, being more rigid, allows early rehabilitation. External fixation has a limited yet defined role for metacarpal fractures with complex soft-tissue injury and/or segmental bone loss. The recent development of bioabsorbable implants holds promise for skeletal rigidity with minimal soft-tissue morbidity, but long-term in vivo data support- ing the use of these implants is not currently available. Copyright © 2002 by the American Society for Surgery of the Hand arly treatment of metacarpal fractures was lim- Surgical techniques rapidly expanded to include ret- ited to the only tools available: manipulation rograde fracture pinning, intramedullary pinning, and Eand casting. The discovery of percutaneous transfixion pinning. Many of the K-wires in use today fracture fixation near the turn of the century opened have the same diamond-shaped tip and sizing speci- up a new world of possibilities. It was 25 years after fications as the original design. Bennett’s original manuscript that Lambotte de- The first plate and screw set for the hand was scribed the first surgical stabilization of a basilar introduced in the late 1930s. By today’s standards, the thumb fracture by using a thin carpenter’s nail.1 By Hermann Metacarpal Bone Set was quite lean; it 1913, Lambotte had authored a fracture text with included 3 longitudinal plates of 2, 3, and 4 holes, a multiple examples of pinning, wiring, and plating of drill, screwdriver, and 9 screws.1 Improvements in hand fractures. -
Clinical Medical Policy
CLINICAL MEDICAL POLICY Noninvasive Electrical Bone Growth Stimulators Policy Name: (osteogenesis stimulators) Policy Number: MP-070-MD-PA Responsible Department(s): Medical Management Provider Notice Date: 12/15/2018 Issue Date: 01/15/2019 Effective Date: 01/15/2019 Annual Approval Date: 10/17/2019 Revision Date: N/A Products: Gateway Health℠ Medicaid Application: All participating hospitals and providers Page Number(s): 1 of 78 DISCLAIMER Gateway Health℠ (Gateway) medical policy is intended to serve only as a general reference resource regarding coverage for the services described. This policy does not constitute medical advice and is not intended to govern or otherwise influence medical decisions. POLICY STATEMENT Gateway Health℠ may provide coverage under the medical-surgical and DME benefits of the Company’s Medicaid products for medically necessary noninvasive electrical bone growth stimulators as treatment of nonunion long bone fractures or congenital pseudarthrosis. This policy is designed to address medical necessity guidelines that are appropriate for the majority of individuals with a particular disease, illness or condition. Each person’s unique clinical circumstances warrant individual consideration, based upon review of applicable medical records. (Current applicable Pennsylvania HealthChoices Agreement Section V. Program Requirements, B. Prior Authorization of Services, 1. General Prior Authorization Requirements.) Policy No. MP-070-MD-PA Page 1 of 78 DEFINITIONS Prior Authorization Review Panel - A panel of representatives from within the PA Department of Human Services who have been assigned organizational responsibility for the review, approval and denial of all PH-MCO Prior Authorization policies and procedures. Non-invasive (Osteogenic) Electrical Bone Growth Stimulator – A device that uses pulsed- electromagnetic fields, capacitative coupling or combined magnetic fields to generate a weak electric current through the target site. -
중수골 단독 골절에 대한 최소 관혈적 정복술 Mini-Open Reduction Of
Arch Hand Microsurg 2019;24(4):321-329. https://doi.org/10.12790/ahm.2019.24.4.321 Archives of pISSN 2586-3290 • eISSN 2586-3533 Hand and Microsurgery Original Article 중수골 단독 골절에 대한 최소 관혈적 정복술 정연진1ㆍ오세영2ㆍ최지선2ㆍ임진수2ㆍ심형섭2 1가톨릭대학교 의과대학 은평성모병원 성형외과학교실, 2가톨릭대학교 의과대학 성빈센트병원 성형외과학교실 Mini-Open Reduction of Isolated Metacarpal Bone Fracture Yeon Jin Jeong1, Se Young Oh2, Ji Seon Choi2, Jin Soo Lim2, Hyung-Sup Shim2 1Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 2Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea Purpose: Metacarpal bone fracture is a commonly encountered. The authors applied a minimally invasive open reduction technique that comprises only a stab incision to treat metacarpal bone fractures, thereby minimizing complications that accompany traditional open reduction methods while retaining the advantages of closed reduction techniques. Methods: A 5-year retrospective study was carried out of all patients who underwent surgical treatment performed by two separate hand surgeons. Total 37 patients were operated. Fourteen patients of conventional open reduction group and 23 patients of minimal invasive group were included in the study. Results: Mini-open reduction group had shorter operative time, comparable radiological reduction result, lower subjec- tive pain, comparable mean active range of motion of the metacarpophalangeal joint, similar complication rate and supe- rior outcome scar quality than conventional open reduction group. Conclusion: Mini-open reduction method may be an alternative to conventional open reduction in treating metacarpal fractures. -
Anatomical Snuffbox and It Clinical Significance. a Literature Review
Int. J. Morphol., 33(4):1355-1360, 2015. Anatomical Snuffbox and it Clinical Significance. A Literature Review La Tabaquera Anatómica y su Importancia Clínica. Una Revisión de la Literatura Aladino Cerda*,** & Mariano del Sol ***,**** CERDA, A & DEL SOL, M. Anatomical snuffbox and it clinical significance. A literature review. Int. J. Morphol., 33(4):1355-1360, 2015. SUMMARY: The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox’s anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area. KEY WORDS: Hand; Wrist; Anatomical Snuffbox; Radial artery; Cephalic vein; Superficial branch of radial nerve; Scaphoid. INTRODUCTION The anatomical snuffbox (AS) is a depression in (Latarjet & Ruíz-Liard). This triangular structure presents a wrist’s radial part, limited by the tendons of abductor longus base formed by the distal margin of the retinaculum of ex- muscle, extensor pollicis brevis and extensor pollicis longus tensor muscles (Kahle et al., 1995), and a vertex conformed muscles (Latarjet & Ruíz-Liard, 2007). This little triangular by the attachment of the tendons of extensor pollicis longus area is often used to perform clinical procedures as the and extensor pollicis brevis muscles (Fig. 2) (Latarjet & cannulation of the cephalic vein, and surgical procedures as Ruíz-Liard). The roof is formed by the skin and superficial placing arteriovenous fistula between the radial artery and cephalic vein, among other uses. -
DISTAL RADIUS FRACTURES: REHABILITATIVE EVALUATION and TREATMENT PDH Academy Course #OT-1901 | 5 CE HOURS
CONTINUING EDUCATION for Occupational Therapists DISTAL RADIUS FRACTURES: REHABILITATIVE EVALUATION AND TREATMENT PDH Academy Course #OT-1901 | 5 CE HOURS This course is offered for 0.5 CEUs (Intermediate level; Category 2 – Occupational Therapy Process: Evaluation; Category 2 – Occupational Therapy Process: Intervention; Category 2 – Occupational Therapy Process: Outcomes). The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA. Course Abstract This course addresses the rehabilitation of patients with distal radius fractures. It begins with a review of relevant terminology and anatomy, next speaks to medical intervention, and then examines the role of therapy as it pertains to evaluation, rehabilitation, and handling complications. It concludes with case studies. Target audience: Occupational Therapists, Occupational Therapy Assistants, Physical Therapists, Physical Therapist Assistants (no prerequisites). NOTE: Links provided within the course material are for informational purposes only. No endorsement of processes or products is intended or implied. Learning Objectives At the end of this course, learners will be able to: ❏ Differentiate between definitions and terminology pertaining to distal radius fractures ❏ Recall the normal anatomy and kinesiology of the wrist ❏ Identify elements of medical diagnosis and treatment of distal radius fractures ❏ Recognize roles of therapy as it pertains to the evaluation and rehabilitation of distal radius fractures ❏ Distinguish -
Management of Rolando and Bennett Fractures Treatment with Pin And
Int J Med Invest 2019; Volume 8; Number 4; 85-90 http://www.intjmi.com Brief Report Management of Rolando and Bennett Fractures Treatment with Pin and Plaster (A New Technique) Masoud Shayesteh Azar 1, Mohammad Hossein Kariminasab 1*, Salman Ghaffari 1, Mani Mahmoudi 2, Abolfazl Kazemi 3, Shadi Shayesteh Azar 4. 1. Associated Professor of orthopedic surgery, Orthopedic Research center, Mazandaran university of medical science, Sari, Iran . 2. Assistant professor of orthopedic surgery, Orthopedic Research center, Mazandaran university of medical science, Sari, Iran. 3. Orthopedic resident, Orthopedic Research center, Mazandaran university of medical science, Sari, Iran 4. Medical Student, Ramsar International University, Mazandaran, Iran. *correspondence: Mohammad Hossein Kariminasab, Associated Professor of orthopedic surgery, Orthopedic Research center, Mazandaran university of medical science, Sari, Iran. Email: [email protected] Abstract: Intra-articular fractures of Thumb are the most common fractures occurred in children and elderly; divided into Bennett & Rolando fractures. The purpose of this article is to introduce new approach for these fractures. In this approach, after pre-surgery techniques; a 1.5-2 mm pin is placed in the proximal distal phalanx. Next, the best reduction is achieved by imposing pulling through the pin and rotating motion under C-Arm. Short forearm cast is then used after that cast changing to thumb Spica cast and the pin is incorporated in the cast, the position of thumb during casting in abduction and pronation depends on the reduction under C-Arm. After the operation, the reduction is controlled by radiography. Within 4-6 weeks, the cast is removed, the pin is taken out, and active and passive joint movements begin. -
Commonly Missed Orthopedic Injuries
Commonly Missed Orthopedic Injuries Holly Adams, PA-C Galveston-Texas City VA Outpatient Clinic Missed Orthopedic Injuries • Overlooking orthopedic injuries is a leading cause of medical malpractice claims out of the ED. • Am J Emergency Med 1996. 14(4):341-5. Karcz et al, 1996. • Massachusetts Joint Underwriters Association: Missed fractures comprised 20% (during1980-1987) and 10% (1988-1990) of malpractice claims. • Fractures are 2nd in claim amount and number of cases established against ED physicians. Radiographics Commonly Missed • Wei (Taipei, Acta Radiol 2006) identified specific regions of misinterpretation: • Foot 7.6% 18/238 • Knee 6.3% 14/224 • Elbow 6.0% 14/234 • Hand 5.4% 10/185 • Wrist 4.1% 25/606 • Hip 3.9% 20/512 • Ankle 2.8% 8/282 • Shoulder 1.9% 5/266 • Tibia/fibula 0.4% 1/226 • Total 3.7% 115/3081 Pitfalls of ER X-Rays • Incorrect interpretation (interpretation errors) • Inadequate (suboptimal) images • Over‐reliance on radiography • Inadequate clinical examination Fractures are a Clinical Diagnosis • 1) Mechanism of injury • 2) Findings on physical examination • 3) Age of the patient. • Radiography confirms the diagnosis and provides anatomical detail. • Fractures can be present without radiographic abnormality. Fractures are a Clinical Diagnosis • If a fracture is clinically suspected • but not radiographically apparent, treat the patient as though a fracture were present with • adequate immobilization and follow‐up (e.g., scaphoid fracture, femoral neck fracture). Fractures are a Clinical Diagnosis • Soft tissue injuries may be more significant that the skeletal injury (ligaments, articular cartilage, neurovascular injuries). • Diagnosis by physical exam or imaging studies: MRI, angiography, arthroscopy, stress views.