Ibrahim Safwat, Cuggy Conor, El-Deib Jamal
Plastic & Reconstructive Surgery Department, Beaumont Hospital, Dublin, Ireland.
Royal College of Surgeons Ireland, Dublin, Ireland.
JPRAS Open. 2024 Nov 16;43:357-365. doi: 10.1016/j.jpra.2024.11.007. eCollection 2025 Mar.
Metacarpal shaft fractures account for 30 % of all hand fractures, and long oblique and spiral shaft fractures represent a significant quantity. Closed or open reduction and internal fixation is generally indicated for unstable fractures, rotational malalignment or significant metacarpal shortening. Various techniques can achieve appropriate fixation, though no single technique has been proven to be superior across all cases. The choice of fixation often depends on the fracture pattern, surgeon expertise and patient factors.
This large series aimed to show that our novel technique can achieve excellent clinical and aesthetic outcomes for metacarpal fractures despite being inferior in biomechanical studies.
Briefly, 120 fractures in 115 hands were included in centres across Ireland and Saudi Arabia between 2016 and 2022. Inclusion criteria were patients with long oblique and spiral metacarpal mid-shaft fractures with significant displacement, metacarpal shortening and/or rotational malalignment. Fixation was achieved via cerclage wires inserted through a minimal dorsal incision. We examined the clinical and radiological outcomes of these patients.
We observed excellent results in our cohort, with 92.5 % of the patients obtaining full passive and active range of motion at the final follow-up. The mean qDASh score was 4.5. There was 1 case of malunion and 1 wire migration. No patients had cosmetic concerns regarding the dorsal hand scars.
Our novel metacarpal cerclage can help patients regain excellent range of motion and avoid extended immobilisation. We believe that this method is technically simple, forgiving to mistakes, affordable and can provide excellent cosmesis.
掌骨干骨折占所有手部骨折的30%，其中长斜形和螺旋形骨干骨折占相当比例。对于不稳定骨折、旋转畸形或明显的掌骨短缩，通常需要进行闭合或切开复位内固定。尽管没有单一技术被证明在所有病例中都更具优势，但各种技术都能实现适当的固定。固定方法的选择通常取决于骨折类型、外科医生的专业技能和患者因素。
本大型系列研究旨在表明，我们的新技术尽管在生物力学研究中表现欠佳，但对于掌骨骨折仍能取得优异的临床和美学效果。
简而言之，2016年至2022年间，爱尔兰和沙特阿拉伯各地的中心纳入了115只手中的120处骨折。纳入标准为长斜形和螺旋形掌骨中骨干骨折且有明显移位、掌骨短缩和/或旋转畸形的患者。通过经最小化背侧切口插入的环扎钢丝实现固定。我们检查了这些患者的临床和放射学结果。
我们观察到队列中的结果优异，92.5%的患者在末次随访时获得了完全被动和主动活动范围。平均qDASh评分为4.5。有1例畸形愈合和1例钢丝移位。没有患者对手背瘢痕有美容方面的担忧。
我们新颖的掌骨环扎术可帮助患者恢复优异的活动范围并避免长时间固定。我们认为该方法技术简单、容错性好、成本低廉且能提供优异的美容效果。
