Philadelphia College of Osteopathic Medicine, PA, USA.
Rothman Institute, Philadelphia, PA, USA.
Hand (N Y). 2023 Jan;18(1):67-73. doi: 10.1177/1558944720988073. Epub 2021 Feb 3.
Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. A comprehensive literature search was performed using electronic databases for both clinical and biomechanical studies in relation to RIS fixation published from 2000 to 2020. A total of 19 studies (13 clinical and 6 biomechanical) met the inclusion criteria. The clinical studies examined 603 metacarpal fractures and demonstrated adequate functional outcomes in terms of grip strength, total active motion, and time to return to work. The biomechanical studies examined 80 metacarpal fractures, finding that load to failure in RISs was often equal to or higher than Kirschner wires but less than plate and screws. The complication rate in reviewed studies was 2.8%, with the most prevalent complications being stiffness and extension lag. RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality.
掌骨骨折的常见固定方式包括经皮克氏针固定、钢板和螺钉固定，以及最近的髓内螺钉固定。逆行髓内钉（RIS）是一种新的方法，10 年前首次描述。本综述的目的是批判性评估评估 RIS 固定掌骨骨折的结果的文献，并为这项新技术创建并发症概况。使用电子数据库对 2000 年至 2020 年发表的与 RIS 固定相关的临床和生物力学研究进行了全面的文献检索。共有 19 项研究（13 项临床研究和 6 项生物力学研究）符合纳入标准。临床研究检查了 603 例掌骨骨折，在握力、总主动运动和恢复工作时间方面均显示出良好的功能结果。生物力学研究检查了 80 例掌骨骨折，发现 RIS 的失效负荷通常等于或高于克氏针，但低于钢板和螺钉。回顾性研究的并发症发生率为 2.8%，最常见的并发症是僵硬和伸展滞后。尽管需要更多高质量的研究来全面检查这种方式，但 RIS 在掌骨骨折中的应用似乎具有足够的稳定性、满意的临床结果和最小的并发症。
