Extra-articular Metacarpal Fractures: Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation
Background/UNASSIGNED:There is no consensus on the optimal operative treatment of isolated closed metacarpal fractures as every technique is associated with advantages and shortcomings. This retrospective study aims to compare the outcomes of single metacarpal, extra-articular fractures treated with closed reduction and percutaneous pinning (CRPP) versus open reduction and internal fixation (ORIF). Methods/UNASSIGNED:The charts of all patients who underwent surgical repair of closed metacarpal fractures at our institutions from 2009 to 2016 were reviewed. 70 patients met the inclusion criteria, 44 had undergone CRPP and 26 ORIF with plate or lag screws. Subgroup analyses of all patients stratified by both fracture pattern and fracture location were performed. Additionally, subgroup analyses of outcomes based on the time from injury to surgery were conducted. Clinical outcomes included immobilization time, total active motion, stiffness, complication and reoperation rates, as well as occupational therapy referral rates and duration. Functional outcomes were determined using the Quick-DASH (Disabilities of the Arm, Shoulder and Hand) score via telephone questionnaire administered retrospectively. Results/UNASSIGNED:Overall, there was no significant difference in functional outcome parameters including total active motion (CRPP 91% of normal vs. ORIF 87% of normal), stiffness, therapy referrals, and complications between treatment groups. Patients treated with CRPP, regardless of fracture pattern or location, were operated on earlier than those treated with ORIF (avg. 7 days vs. 15 days). The immobilization time for patients treated with ORIF was significantly less than those treated with CRPP (19.7 vs. 30.7 days; p=0.001). This difference in the immobilization time also reflected the outcomes of the subgroup analyses based on the post-injury time of surgery. When transverse shaft fractures were examined independently as a subgroup, ORIF resulted in improved post-operative range of motion vs. CRPP (100% normal vs. 91% normal). The mean DASH score for each group was satisfactory and the difference was not statistically significant (16.3 for the CRPP and 18.7 for the ORIF group, p=0.805). Conclusion/UNASSIGNED:Both CRPP and ORIF are viable techniques with good clinical outcomes and low complication rates. ORIF of closed metacarpal fractures allowed for earlier mobilization when compared with CRPP without compromising fracture stability, clinical or functional short-term outcomes.
Calibrated lateral crus stabilizer
BACKGROUND:Fundamental shortcomings of the currently available instrumentation prompted the need for a device that facilitates stabilization of the lateral crus while at the same time allowing for precise measurement of the retained cartilage fragment along the anatomic axis of the lateral crus. METHODS:This article presents a new instrument, the calibrated lateral crus stabilizer, and highlights its unique features, which facilitate the precise and symmetric excision of the lateral crural cartilage. RESULTS:A lateral crus stabilizer with a calibration mechanism is introduced that provides the means for precise removal of the excess portion of the lower lateral cartilage during rhinoplasty. CONCLUSIONS:There was a need for improved instrumentation to stabilize the alar cartilage than what is currently available. New instrumentation is presented that answers that need.