Clin Orthop Surg.  2019 Mar;11(1):120-125. 10.4055/cios.2019.11.1.120.

A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study

• Oh JR
• Kim DS
• Yeom JS
• Kang SK
• Kim YT

• KMID: 2438342
• DOI: http://doi.org/10.4055/cios.2019.11.1.120

Abstract

BACKGROUND
We sought to estimate the ultimate tensile strength after metacarpal shaft fracture repair in adults using three operative fixation methods: plate fixation, Kirschner wire (K-wire) fixation, and intramedullary headless compression screw fixation. We also compared the advantages and disadvantages of each operative technique.
METHODS
We acquired 30 metacarpal bones from four Korean adult cadavers without trauma, operative history, or deformities. The 30 metacarpal bones were divided into ten groups consisting of three metacarpal bones each with matching sizes and lengths. They were fractured, reduced, and fixed with plate and screws, K-wires, or headless compression screws. We performed force testing, collected ultimate tensile strength data, and created a stress-strain graph.
RESULTS
The ultimate tensile strength of ten groups according to the fixation method was as follows: late and screw fixation, 246.1 N (range, 175.3 to 452.4 N); K-wire fixation, 134.6 N (62.7 to 175.0 N); and intramedullary headless compression screw fixation, 181.2 N (119.2 to 211.7 N). The median tensile strength of each fixation method was significantly different. In addition, the post-hoc test showed significant difference between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.
CONCLUSIONS
The tensile strength median values decreased in the following order showing significant differences among the fixation methods: plate and screw fixation, headless compression screw fixation, K-wire fixation. Significant differences were also observed between the plate and screw fixation and K-wire fixation, between the headless compression screw fixation and K-wire fixation, and between the headless compression screw fixation and plate and screw fixation.

Keyword

Metacarpal; Metacarpal shaft fracture; Cadaver; Headless compression screw

MeSH Terms

Adult*
Cadaver*
Congenital Abnormalities
Humans
Metacarpal Bones
Methods
Tensile Strength*

Figure

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  Fig. 1 (A) I plate (1.0 mm in thickness; Jeil Medical, Seoul, Korea) and self-tapping cortical screws (2.0 mm in diameter, Jeil Medical). (B) Arix headless cannulated compression screws (3.0 mm in diameter, Jeil Medical).

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  Fig. 2 (A) Three metacarpal shaft fractures of the cadaver bones fixed with the Kirschner wire (K-wire), headless compression screw, or plate fixation (from left to right). (B) Articular surface of the metacarpal head fixed with the headless compression screw method. This screw does not protrude and has minimal invasion of the articular surface area.

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  Fig. 3 Force test system (Multitest 2.5-i; Mecmesin, Horsham, UK).

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  Fig. 4 Measurement of tensile strength by the force test system. (A) Plate fixation. (B) K-wire fixation. (C) Headless compression screw fixation.

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  Fig. 5 Stress-strain graph based on force testing of three metacarpal bone fracture sites in group 2, each of which was fixed with a plate, Kirschner wire (K-wire), or headless compression screw.

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