AI Article Synopsis

  • The study aimed to compare two fixation strategies for metacarpal fractures: plating and intramedullary nailing, focusing on which method restores the original strength of the bone more effectively.
  • Using cadaveric hands, researchers tested the fracture strength of metacarpals fixed with either method, finding that intramedullary nailing achieved results closer to the natural strength of the bone than plating, especially in the little, middle, and index fingers.
  • The study concluded that intramedullary nailing is biomechanically superior to plate fixation for midshaft metacarpal fractures, suggesting it as the preferred method for appropriate fracture patterns.

Article Abstract

Purpose: The purpose of our study was to evaluate the ultimate load to failure for 2 metacarpal fracture fixation strategies, plating versus intramedullary nailing, and then compare them to the native metacarpal. Our hypothesis was that the intramedullary nail after fracture fixation would more closely restore the native strength of the metacarpal when compared to plate fixation.

Methods: Matched pairs of cadaveric hands (age range, 19-49; 5 men and 6 women) were dissected to produce 88 intact and equally distributed metacarpals (little, ring, middle, and index fingers). The metacarpals were then randomly selected to undergo either plate fixation or intramedullary nail fixation. A 3-point bending model was used to test the native metacarpal strength to the point of fracture and, subsequently, the fracture fixation construct. The data were then compared against the native metacarpal for normalized load to failure, normalized displacement, and stiffness.

Results: The normalized maximum force (ratio of fixation:native) for the intramedullary nail specimens was significantly closer to normal than for the plated specimens for the little, middle, and index fingers, as well as for all metacarpals combined. We did not detect a difference in maximum force for the ring finger.

Conclusions: When compared to plate fixation, metacarpal intramedullary nailing more closely restores the ultimate load to failure of the native metacarpal after midshaft fracture.

Clinical Relevance: For metacarpal fracture patterns amenable to intramedullary screw fixation, an intramedullary nail has biomechanical properties that are superior to a plate and screws in a 3-point bending model.

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Source
http://dx.doi.org/10.1016/j.jhsa.2022.04.020DOI Listing

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