Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
J Hand Surg Am. 2023 Jul;48(7):739.e1-739.e8. doi: 10.1016/j.jhsa.2022.01.026. Epub 2022 Mar 16.
The incidence of and associated risk factors for implant removal following the plate-and-screw fixation of metacarpal shaft fractures have not been well described. The primary objective of our study was to identify implant-related radiographic parameters associated with implant removal in patients treated with the plate-and-screw fixation of isolated, displaced metacarpal fractures at 2 years of follow-up. The secondary objective of our study was to identify patient-related factors associated with implant removal.
A retrospective study of all patients who underwent open treatment of a metacarpal fracture with a plate-and-screw construct from January 1, 2000, to April 30, 2019, at 2 level-1 trauma centers was conducted. After the application of exclusion criteria, we identified 138 patients with a single isolated metacarpal fracture of a nonthumb digit treated with open reduction and internal fixation using a plate-and-screw construct. Our study endpoint was the removal of the plate-and-screw construct or a minimum of 2 years of follow-up without the removal of the hardware. Twenty-three patients achieved our study endpoint as determined using their electronic medical records, and 58 additional patients were reached via telephone to confirm their implant removal status. A bivariate analysis was used to screen for factors associated with implant removal, and variables significant in the bivariate screen were included in a multivariable stepwise logistic regression model.
Twenty-three out of 81 patients (28%) in our final cohort underwent implant removal by the final follow-up visit. In the logistic regression analysis, the distance between the plate and metacarpophalangeal joint, the distance between the plate and carpometacarpal joint, and active smoking were independently associated with implant removal.
The proximity of metacarpal plates to adjacent joints is associated with subsequent implant removal. Patients may be counseled about the higher risk of implant removal when periarticular metacarpal plating is performed.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.
掌骨干骨折钢板螺钉固定后取出内固定的发生率及相关危险因素尚未得到很好的描述。我们研究的主要目的是确定与 2 年随访时接受掌骨干骨折钢板螺钉固定的患者相关的影像学参数与内固定取出的关系。我们研究的次要目的是确定与内固定取出相关的患者相关因素。
对 2000 年 1 月 1 日至 2019 年 4 月 30 日在 2 个 1 级创伤中心接受钢板螺钉固定治疗的掌骨骨折患者进行回顾性研究。在应用排除标准后，我们确定了 138 例非拇指单个掌骨骨折患者，采用切开复位内固定钢板螺钉固定治疗。我们的研究终点是取出钢板螺钉固定物或至少 2 年的随访而无需取出内固定物。通过电子病历确定 23 例患者达到我们的研究终点，通过电话联系另外 58 例患者以确认其植入物去除状态。使用双变量分析筛选与植入物去除相关的因素，将双变量筛选中有意义的变量纳入多变量逐步逻辑回归模型。
在我们最终队列的 81 例患者中，有 23 例（28%）在最终随访时接受了植入物去除。在逻辑回归分析中，钢板与掌指关节之间的距离、钢板与腕掌关节之间的距离以及吸烟是与植入物去除独立相关的因素。
掌骨干钢板与相邻关节的接近程度与随后的植入物去除有关。当进行关节周围掌骨干钢板固定时，可能需要告知患者更高的植入物去除风险。
研究类型/证据水平：预后 IV 级。
