AI Article Synopsis
- The study aimed to assess the outcomes of treating comminuted open fractures of the metacarpal bone using antegrade intramedullary nailing (AIN) in patients with soft tissue, tendon, and neurovascular injuries, evaluated at least two years after surgery.
- The research included 27 patients and utilized radiographic imaging and clinical assessments (like pain and functional scores) to measure recovery, with successful bone union occurring at an average of 12.3 weeks and significant improvements in bone alignment and shortening.
- Results showed satisfactory recovery with low pain scores, good range of motion, and grip strength close to the normal side, suggesting that AIN is an effective and uncomplicated method for treating these complex fractures
Article Abstract
Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2 years postoperatively.
Methods: Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up.
Results: The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38 mm. Union was achieved at mean 12.3 weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05 mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis.
Conclusions: AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation.
Level Of Evidence: Level IV, Retrospective case series.
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| http://dx.doi.org/10.1007/s00402-021-03960-7 | DOI Listing |
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