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Headless Screw Fixation of Metacarpal Neck Fractures: A Mechanical Comparative Analysis
Journal article   Open access   Peer reviewed

Headless Screw Fixation of Metacarpal Neck Fractures: A Mechanical Comparative Analysis

Christopher M Jones, Eric M Padegimas, Nicole Weikert, Samuel Greulich, Asif M Ilyas and Sorin Siegler
Hand (New York, N.Y.), v 14(2), pp 187-192
Mar 2019
DOI: https://doi.org/10.1177/1558944717731859
PMID: 28933187
url
https://doi.org/10.1177/1558944717731859View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Bone Plates Bone Screws Bone Wires Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Fractures, Bone - surgery Humans Materials Testing Metacarpal Bones - injuries Metacarpal Bones - surgery Models, Anatomic Printing, Three-Dimensional Stress, Mechanical
The purpose of this study was to compare the mechanical properties of metacarpal neck fracture fixation by headless compression screw (HCS) with that of Kirschner wire (KW) cross-pinning and locking plate (LP) fixation. A metacarpal neck fracture was created in 30 fourth-generation composite Sawbones metacarpal models. A volar-based wedge was removed using a custom jig to simulate a typical apex dorsal fracture, unstable in flexion. The models were divided into 3 equal groups based on the method of fixation: retrograde cross-pinning with two 1.2-mm KWs, 2.0-mm dorsal T-plate with six 2.0-mm locking screws (LP), and a 3.0-mm retrograde HCS. Models were fixed at the proximal end, mounted in a material testing machine, and loaded through a cable tensioned over the metacarpal head, simulating grip loading. Cyclic loading from 0 to 40 N was performed, followed by loading to failure. Load, displacement, and failure mode were recorded. Stiffness of the HCS (7.3 ± 0.7 N/m) was significantly greater than the KW (5.8 ± 0.5 N/m) but significantly less than the LP (9.5 ± 1.9 N/m). With cyclic loading to 40 N, the LP exhibited significantly less displacement (0.2 ± 1.3 mm) compared with the HCS (2.5 ± 2.3 mm) and KW (2.8 ± 1.0 mm). Load to failure for the HCS (215.5 ±3 9.0 N) was lower than that of the KW (279.7 ± 100.3 N) and of the LP (267.9 ± 44.1 N), but these differences were not statistically significant. The HCS provided mechanical fracture fixation properties comparable with KW fixation. The LP construct allowed significantly less displacement and had the highest strength of the 3 fixation methods.

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