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Ideal Length and Diameter for Intramedullary Screw Fixation of Metacarpal Fractures: A Biomechanical Study.
Yamaguchi, Kent T; Telfer, Scott; Iannuzzi, Nicholas; Hoang, Don; Huang, Jerry I.
Afiliación
  • Yamaguchi KT; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
  • Telfer S; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
  • Iannuzzi N; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
  • Hoang D; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
  • Huang JI; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
J Hand Surg Glob Online ; 5(2): 189-195, 2023 Mar.
Article en En | MEDLINE | ID: mdl-36974302
Purpose: This biomechanical study evaluated the effect of intramedullary screw diameter and length relative to 3-point bending force and torsional force when used to stabilize metacarpal shaft fractures. Methods: Transverse osteotomies were made in the proximal metacarpal shaft in 36 middle finger metacarpal fourth-generation composite Sawbones. To compare screw diameters, antegrade intramedullary screws of 30-mm length were placed in 6 metacarpals, which included 4.7-mm Acutrak 2, Standard Acutrak 2 (4.0 mm), and Mini-Acutrak 2 (3.5 mm) screws. To compare screw lengths, metacarpals were fixated with Standard Acutrak 2 screws of 26, 30, or 34 mm in length, with screw tips bypassing the osteotomy by 6, 10, or 14 mm, respectively. A 6 degrees of freedom robot was used for torsional and 3-point bending testing. Results: Increasing screw diameter demonstrated significant differences in both 3-point bending and torsional strengths. Maximum torsional loads were 69 Ncm (4.7-mm Acutrak 2), 45 Ncm (Standard Acutrak 2), and 27 Ncm (Mini-Acutrak 2) (P < .05). Loads to failure in the 3-point bending tests were 916 N (4.7-mm Acutrak 2), 713 N (Standard Acutrak 2), and 284 N (Mini-Acutrak 2) (P < .05). Differing screw lengths demonstrated significant differences with maximum torsional loads when comparing the 26-mm screws (22 Ncm) with 30- and 34-mm screws (45 and 55 Ncm, respectively) (P < .05). The 3-point dorsal bending strengths were significantly different between the 26-mm screws (320 N) and 30- and 34-mm screws (713 N and 702 N, respectively) (P < .05). Conclusions: The results demonstrated significantly higher torsional strength and resistance to 3-point bending with larger intramedullary screw diameters. Further, when selecting the intramedullary screw length, the screw tip should pass at least 10 mm beyond the fracture. Clinical Relevance: This study provided biomechanical evidence to guide surgeons in selecting intramedullary screw diameter and length for treating metacarpal fractures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Hand Surg Glob Online Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Hand Surg Glob Online Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos