Advertisement

Fracture Fixation Strength in Metacarpal Plating Versus Intramedullary Nailing Using a 3-Point Bending Model: A Cadaveric, Biomechanical Study

      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gajendran V.K.
        • Szabo R.M.
        • Myo G.K.
        • Curtiss S.B.
        Biomechanical comparison of double-row locking plates versus single- and double-row non-locking plates in a comminuted metacarpal fracture model.
        J Hand Surg Am. 2009; 34: 1851-1858
        • Avery III, D.M.
        • Klinge S.
        • Dyrna F.
        • et al.
        Headless compression screw versus Kirschner wire fixation for metacarpal neck fractures: a biomechanical study.
        J Hand Surg Am. 2017; 42: 392.e1-392.e6
        • Black D.
        • Mann R.J.
        • Constine R.
        • Daniels A.U.
        Comparison of internal fixation techniques in metacarpal fractures.
        J Hand Surg Am. 1985; 10: 466-472
        • Doht S.
        • Jansen H.
        • Meffert R.
        • Frey S.
        Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model.
        Int Orthop. 2012; 36: 1641-1646
        • Warrender W.J.
        • Ruchelsman D.E.
        • Livesey M.G.
        • Mudgal C.S.
        • Rivlin M.
        Low rate of complications following intramedullary headless compression screw fixation of metacarpal fractures.
        Hand (N Y). 2020; 15: 798-804
        • Fusetti C.
        • Meyer H.
        • Borisch N.
        • Stern R.
        • Santa D.D.
        • Papaloïzos M.
        Complications of plate fixation in metacarpal fractures.
        J Trauma. 2002; 52: 535-539
        • ten Berg P.W.
        • Mudgal C.S.
        • Leibman M.I.
        • Belsky M.R.
        • Ruchelsman D.E.
        Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures.
        J Hand Surg Am. 2013; 38: 322-330.e2
        • Boulton C.L.
        • Salzler M.
        • Mudgal C.S.
        Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report.
        J Hand Surg Am. 2010; 35: 1260-1263
        • Dabezies E.J.
        • Schutte J.P.
        Fixation of metacarpal and phalangeal fractures with miniature plates and screws.
        J Hand Surg Am. 1986; 11: 283-288