FOR THE MEDICAL PRACTITIONER
Traumatology
doi: 10.25005/2074-0581-2025-27-4-1025-1035
OSTEOSYNTHESIS FOR HIGH-ENERGY METACARPAL INJURIES

V.V. LOKSHINA1,2, V.E. DUBRO2, V.S. MELNIKOV1,3, A.S. ZELYANIN1,2, I.S. ZHALYALOV1,2

1Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital, Moscow, Russian Federation
2Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
3Department of Oncology, Radiotherapy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

Objective: To conduct a prospective study of early outcomes of treatment of patients with severe mauled injuries to the metacarpal area of the hand and/or transmetacarpal amputations at 6 weeks.

Methods: From January 1, 2022, to May 31, 2025, 32 patients with severe mauled injuries to the metacarpal area of the hand were treated at the Center for Hand Surgery and Reconstructive Microsurgery at the S.S. Yudin City Clinical Hospital, Moscow, Russia. Thirteen patients were excluded from the study due to extensive skin and soft-tissue defects. The following factors were assessed for 19 patients: duration of the surgery, severity of postoperative pain, fixator loosening, and secondary displacement. Among these patients, 8 with diaphyseal fractures underwent intramedullary pinning, 1 received K-wire (also known as Kirschner wires) combined with screw osteosynthesis, 1 underwent conversion from temporary external fixation to definitive external plate fixation, and 9 with fractures in the metaphyseal area underwent K-wire osteosynthesis. Hand function and range of motion were not assessed due to the short observation period.

Results: The average duration of pin osteosynthesis was similar to that of K-wire osteosynthesis. The average visual analogue pain score (VAS) after pin osteosynthesis was 1.7, compared with 1.9 after K-wire osteosynthesis. Wire migration was observed in 2 patients, and necrosis of the replanted fingers occurred in 2 patients as well. The immobilization period for the hand and wrist joint following K-wire osteosynthesis lasted six weeks. In contrast, the immobilization periods after pin osteosynthesis varied: 1 week without tendon damage, 3 weeks with damage to the flexor tendons, and 6 weeks with damage to the extensor tendons. Patients began rehabilitation 7 to 10 days after pin osteosynthesis, while rehabilitation after K-wire osteosynthesis started 19 to 21 days post-surgery.

Conclusion: Pin osteosynthesis is a preferred method for treating fractures of metacarpal bones in severe hand injuries. This approach reduces the risk of secondary displacement of fragments and promotes early rehabilitation.

Keywords: Severe hand injuries, osteosynthesis of metacarpal bones, intramedullary osteosynthesis, osteosynthesis with a pin.

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References
  1. Agarwal R, Agarwal D, Agarwal M. Approach to mutilating hand injuries. J Clin Orthop Trauma. 2019;10(5):849-52. https://doi.org/10.1016/j.jcot.2019.08.004
  2. Mattiassich G, Rittenschober F, Dorninger L, Rois J, Mittermayr R, Ortmaier R, et al. Long-term outcome following upper extremity replantation after major traumatic amputation. BMC Musculoskelet Disord. 2017;18(1):77. https://doi. org/10.1186/s12891-017-1442-3
  3. Hanel DP, Chin SH. Wrist level and proximal-upper extremity replantation. Hand Clin. 2007;23(1):13-21. https://doi.org/10.1016/j.hcl.2007.01.001
  4. Bhardwaj P, Sankaran A, Sabapathy SR. Skeletal fixation in a mutilated hand.Hand Clin. 2016;32(4):505-17. https://doi.org/10.1016/j.hcl.2016.06.001
  5. Jahss SA. Fractures of the metacarpals: A new method of reduction and immobilization. J Bone Joint Surg. 1938;20(1):178-86.
  6. Belousov AE. Mikrokhirurgiya v travmatologii [Microsurgery in traumatology]. Leningrad: Meditsina. Leningr. otd-nie; 1988. 223 p.
  7. Macrì M, Pugliese P, Accardo G, Clemente A, Cecconato V, Odella S, et al. Current principles in the management of a mangled hand. J Hand Surg Glob Online. 2024;7(2):326-30. https://doi.org/10.1016/j.jhsg.2024.07.009
  8. Okumuş A, Cerci Ozkan A. Upper extremity replantation results in our series and review of replantation indications. Turkish Journal of Trauma & Emergency Surgery. 2020; 26(1):123-9. https://doi.org/10.14744/tjtes.2019.85787
  9. Poore SO, Israel JS, Rao VK. Thirty-year follow-up of total hand replantation: A case report. Ann Plast Surg. 2016;76(5):521-3. https://doi.org/10.1097/ SAP.0000000000000299
  10. Sabapathy SR, Venkatramani H, Ramkumar S, Mohan M, Zhang D. Crosshand replantation. Indian J Plast Surg. 2020;53(1):124-30. https://doi. org/10.1055/s-0040-1709951
  11. Zyluk A, Chrapusta A, Jabłecki J, Romanowski L, Mazurek T. Three-year (20142016) activity report of the Replantation Service for hand amputations in Poland. Polski przeglad chirurgiczny. 2018;90(4):1-5. https://doi. org/10.5604/01.3001.0011.8176
  12. Żyluk A, Chrapusta A, Jabłecki J, Romanowski L, Mazurek T, Domanasiewicz A. Three-year (2017-2019) activity report of the Replantation Service for hand amputations in Poland. Polski przeglad chirurgiczny. 2021;93(2):26-32. https:// doi.org/10.5604/01.3001.0014.8089
  13. Podszus B, Bigner J, Manas N, DeJesus R. Intra-medullary nail fixation as a treatment method for impending fracture non-union of a near-total trans-metacarpal amputation initially treated with K-wire fixation – A case report. Orthoplastic Surgery. 2024;16(С):1-6. https://doi.org/10.1016/j. orthop.2024.01.003
  14. Lahiri A. Managing mutilating hand injuries. Clin Plast Surg. 2019;46(3):351-7. https://doi.org/10.1016/j.cps.2019.02.009
  15. Tosti R, Eberlin KR. "Damage Control" hand surgery: Evaluation and emergency management of the mangled hand. Hand Clin. 2018;34(1):17-26. https://doi. org/10.1016/j.hcl.2017.09.002
  16. Giron A, Cox CT, Choi E, Baum G, McKee D, MacKay BJ. Outcomes of threaded intramedullary headless nail fixation for metacarpal fractures. Cureus. 2023;15(11):e48618. https://doi.org/10.7759/cureus.48618
  17. Wallace DR, Shiver AL, Pulliam SK, Byrd BM, McGee-Lawrence ME, Snoddy MC. Intramedullary threaded nail fixation versus plate and screw construct in metacarpal neck fractures: A biomechanical study. J Am Acad Orthop Surg. 2023;31(11):e516-e522. https://doi.org/10.5435/JAAOS-D-22-00595
  18. Panattoni JB, Ahmed MM, Busel GA. An ABC technical algorithm to treat the mangled upper extremity: Systematic surgical approach. J Hand Surg. 2017;42(11):934.e1-934.e10. https://doi.org/10.1016/j.jhsa.2017.08.017
  19. Anderson SR, Vincent JA, Wimalawansa SM. Multi-staged management of a mangled, exploded hand crush injury with long-term outcome: The critical link between surgery and therapy. BMJ Case Reports. 2022;15(5):e248429. https:// doi.org/10.1136/bcr-2021-248429
  20. Woo SH. Practical tips to improve efficiency and success in upper limb replantation. Plast Reconstr Surg. 2019;144(5):878e-911e. https://doi. org/10.1097/PRS.0000000000006134

Authors' information:

Lokshina Viktoriya Valerievna,
Traumatologist-Orthopedist, Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital; Postgraduate Student, Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University
ORCID ID: 0009-0008-1663-1567
E-mail: lokshina.v.v@gmail.com

Dubrov Vadim Erikovich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University
Scopus ID: 57207609736
ORCID ID: 0000-0001-5407-0432
SPIN: 8598-7995
E-mail: vduort@gmail.com

Melnikov Viktor Sergeevich,
Candidate of Medical Sciences, Head of the Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital; Assistant Professor of the Department of Oncology, Radiother apy, and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University
ORCID ID: 0000-0003-4873-775X
SPIN: 5677-6362
E-mail: melnikovmd@mail.ru

Zelyanin Aleksandr Sergeevich,
Doctor of Medical Sciences, Professor of the Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University; Traumatologist-Orthopedist, Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital
ORCID ID: 0000-0003-0969-9594
SPIN: 4097-9357
E-mail: microsurgery@inbox.ru

Zhalyalov Ilyas Sayarovich,
Traumatologist-Orthopedist, Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital; Postgraduate Student, Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University
ORCID ID: 0000-0002-3253-0765
E-mail: bratil8@gmail.com

Information about support in the form of grants, equipment, medications

This article was written in the context of agreements between the autonomous non-profit organization, the Center for Innovative Technologies in Healthcare, and S.S. Yudin City Clinical Hospital, Moscow, Russia. The agreements are dated April 28, 2022 (No. 2412-32/22) and concern the grant for the project titled "Method of Minimally Invasive Intramedullary Osteosynthesis of the Metacarpal Bones of the Hand". Another agreement, dated April 3, 2025 (No. 110923/25), relates to a grant for the project "Creation of a System for the Treatment and Rehabilitation of Patients with the Consequences of High-Energy Injuries to the Upper Limb". The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Lokshina Viktoriya Valerievna
Traumatologist-Orthopedist, Center for Hand Surgery and Reconstructive Microsurgery, S.S. Yudin City Clinical Hospital; Postgraduate Student, Department of Traumatology, Orthopedics, and Disaster Medicine, Faculty of Fundamental Medicine, Lomonosov Moscow State University

115446, Russian Federation, Moscow, Kolomensky passage, 4

Tel.: +7 (915) 1165826

E-mail: lokshina.v.v@gmail.com


This work is licensed under a Creative Commons Attribution 4.0 International License.

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