The comparative strengths of internal fixation techniques

doi:10.1016/S0363-5023(84)80145-8

The Journal of Hand Surgery

Volume 9, Issue 2, March 1984, Pages 216-221

https://doi.org/10.1016/S0363-5023(84)80145-8 Get rights and content

The strengths of internal fixation techniques have been compared by transecting human cadaver metacarpals, reducing and fixing the fractures, and then applying forces to mechanically bend the bone during simulated flexion. Kirschner wires alone, intraosseous wire loops with and without Kirschner wires, and bone plates were tested. Intraosseous loops were tested in three configurations, each with four different wire gauges. Intraosseous loops were stronger than Kirschner wires. Right-angle loops were the best of the intraosseous configurations. The addition of a Kirschner wire strengthened the best dorsopalmar intraosseous loops but not the best right-angle loops. Dorsal bone plates were comparable with the best intraosseous loop configurations of 26-gauge wire.

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Cited by (75)

Intramedullary Nail Fixation for Metacarpal Fracture: A Case Report and Review of the Clinical and Biomechanical Evidence
2024, Journal of Hand Surgery Global Online
We present two cases of complex metacarpal fractures treated with an intramedullary locking nail. This is an emerging fixation method that minimizes tissue insult, provides sufficient stability, and allows early mobilization. Locking nails accommodate the capture of fractured fragments in complex unstable patterns and provide longitudinal and rotational stability. The described intrafocal technique is intended to improve coaxial placement of the wire into the medullary canal.
Comparison of low-profile locking plate fixation versus antegrade intramedullary nailing for unstable metacarpal shaft fractures––A prospective comparative study
2019, Injury
The purpose of this study was to compare the effectiveness of mini-open antegrade intramedullary nailing (AIN) and open reduction and internal fixation (ORIF) using the low-profile locking plate for angulated metacarpal shaft fractures, through prospective comparative trial.
Group 1 (mini-open AIN; 40 patients) and the other consecutive patients in group 2 (locking plate; 35 patients) who met our inclusion/exclusion criteria were investigated between January 2010 and December 2016. We compared radiological findings (e.g., union and residual angulation or shortening); clinical conditions (e.g., pain, measured on a visual analog scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores); active range of motion (ROM); and grip strength.
Union was achieved in both groups without any major complications. The final angulation measurements were not significantly different (p = 0.402). The final VAS scores were not different (p = 0.868); however, the final DASH score was better in group 1 than in group 2 (p = 0.034). The plates were removed in 14 patients at 9.6 months postoperatively for various reasons. Mean ROM at the time of hardware removal in these 14 patients was significantly lower compared with the final ROM in groups 1 and 2 (non-removal patients). Final grip strengths recovered significantly more in group 1 than in group 2 (p = 0.029). Extension lag was found in four patients in group 2, and the mean amount was 15°; however, it was resolved by tenolysis during hardware removal.
Both mini-open AIN and low-profile plate fixation are excellent options for metacarpal shaft fractures without significant radiological or clinical problems; however, some clinical outcomes evaluated at least 2 years postoperatively, such as DASH scores and grip strength, were better in the AIN group than in the locking plate group. Plate removal was performed under anesthesia in some patients in the plate group for various reasons, and this may have caused the small differences in the final outcomes evaluated 2 years after surgery.
Kirschner Wires Versus Titanium Plates and Screws in Management of Unstable Phalangeal Fractures: A Randomized, Controlled Clinical Trial
2019, Journal of Hand Surgery
To compare clinical, radiological and functional outcomes of percutaneous K-wires and lateral titanium plates and screws in the management of unstable extra-articular proximal and middle phalangeal fractures.
In a randomized controlled clinical trial, 40 patients with unstable transverse, long oblique or spiral diaphyseal fractures of the proximal and middle phalanges were divided into 2 groups: the K-wire group (20 patients), which included 12 proximal and 8 middle phalangeal fractures fixed by percutaneous K-wires; and the plate group (20 patients), which included 13 proximal and 7 middle phalangeal fractures treated with open reduction and internal fixation with a lateral titanium plate and screws. The patients were observed for at least 6 months (mean [range], 6.9 [6–8] months). Results were evaluated by total active motion (TAM), grip strength, fracture union, pain assessed by visual analog scale and the Quick–Disabilities of the Arm, Shoulder, and Hand questionnaire, and complications.
Clinical and radiological union was achieved in all patients except one in the K-wire group. Mean TAM was significantly better in the plate group than in the K-wire group. Both groups were similar in terms of postoperative loss of grip strength compared with the opposite healthy hand, and as assessed by visual analog scale and the Quick–Disabilities of the Arm, Shoulder, and Hand questionnaire. Fewer complications occurred in the plate group (2 of 20 patients) compared with the K-wire group (5 of 20 patients).
Fixation of unstable proximal and middle phalangeal fractures using a titanium plate and screws through a midlateral approach is a reliable and safe method for most fracture types and is associated with higher TAM and fewer complications.
Therapeutic II.
Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures
2015, Journal of Hand Surgery
To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires.
Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct.
All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size.
The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires.
When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability in the plane of finger flexion-extension.
Biomechanical evaluation of 5 fixation devices for proximal interphalangeal joint arthrodesis
2014, Journal of Hand Surgery
To determine in a cadaver model which, among 5 fixation methods for proximal interphalangeal (PIP) joint arthrodesis, has the greatest stiffness.
Thirty-five cadaver digits were randomly assigned to 1 of 5 fixation groups: oblique K-wire with coronal intraosseous wiring, tension-band wire (TBW), dorsal plate, intramedullary linked screw (IMS), and 90/90 wiring (90/90W). Testing was done by applying bending moments to the PIP joint in the sagittal and frontal planes. The force/displacement curves were used to estimate the stiffness of each construct. Ultimate strength was determined by loading to failure in extension.
The IMS had significantly higher stiffness than all wiring constructs in all planes of motion and significantly greater stiffness in extension than the dorsal plate. The IMS stiffness exceeded 10 N/mm across all bending directions and showed an ultimate strength of 21 N. The plate demonstrated higher stiffness in radial bending than the oblique K-wire with coronal intraosseous wiring and TBW. There were no differences in stiffness between the IMS and plate in all modes of testing except extension. Load-to-failure testing of the devices showed the IMS device to be significantly stronger than the TBW, 90/90W, and plating constructs.
The IMS resisted larger bending moments than all wiring constructs and showed the greatest ultimate strength when compared with 3 of the tested arthrodesis techniques. The plate was significantly better than 2 of the wiring constructs, but only in radial bending. No differences were found between the, TBW, and 90/90W when compared with each other.
The stiffness necessary for a successful PIP joint fusion has not been quantified, but according to this study, the IMS was the most favorable biomechanical construct for initial stability.
The biomechanics of fixation techniques for hand fractures
2013, Hand Clinics
Citation Excerpt :
The plate fixation was significantly more rigid under axial loads than the next strongest method of fixation (2 lag screws), but fixation was not statistically significantly different in bending or torsion.16 One series suggests that appropriate interosseous configurations for the fixation of simulated transverse metacarpal fractures (90° loop positioning of two 26-gauge loops) are comparable in strength with nonlocked plating.21 Although it can be technically demanding and requires additional soft tissue exposure, the fixation is generally low profile and applies adequate compression at the fracture site.

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The comparative strengths of internal fixation techniques

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