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
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References
- 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
- Headless compression screw versus Kirschner wire fixation for metacarpal neck fractures: a biomechanical study.J Hand Surg Am. 2017; 42: 392.e1-392.e6
- Comparison of internal fixation techniques in metacarpal fractures.J Hand Surg Am. 1985; 10: 466-472
- Higher stability with locking plates in hand surgery? Biomechanical investigation of the TriLock system in a fracture model.Int Orthop. 2012; 36: 1641-1646
- Low rate of complications following intramedullary headless compression screw fixation of metacarpal fractures.Hand (N Y). 2020; 15: 798-804
- Complications of plate fixation in metacarpal fractures.J Trauma. 2002; 52: 535-539
- Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures.J Hand Surg Am. 2013; 38: 322-330.e2
- Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report.J Hand Surg Am. 2010; 35: 1260-1263
- Fixation of metacarpal and phalangeal fractures with miniature plates and screws.J Hand Surg Am. 1986; 11: 283-288
Article info
Publication history
Published online: July 05, 2022
Accepted:
April 6,
2022
Received:
July 28,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
