Correlation between tibial nail length and olecrenon to 5th metacarpal head measurement: An anthropometric study.

PURPOSE: During fracture fixation, the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important. This study aims to find out whether "olecranon to 5th metacarpal head" (O-MH) measurement can be used to reliably predict the tibial nail length. METHODS: This was a cross sectional study involving 100 volunteers. Measurements were done and recorded by two observers on two separate occasions. Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus (TT-MM). O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched. Statistical analysis was done to find out correlation between two measurements and influence of age, gender and body mass index on them. RESULTS: Paired t-test showed no systematic error between the readings. Intraclass correlation coefficient showed strong agreement in inter and intra observer settings. Strong correlation was found between the TT-MM & O-MH measurements using Pearson's correlation coefficient test (r = 0.966). Hierarchical regression analysis showed age, gender and BMI have no statistically significant bearings on these measurements and their correlations. CONCLUSION: O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.

Osteochondral Autograft Transplantation Surgery for Metacarpal Head Defects.

Post-traumatic osteonecrosis of the metacarpal head is a challenging problem, particularly in younger patients in whom arthroplasty may not be a durable option. Although several osteochondral reconstructive options have been proposed, some are associated with considerable donor site morbidity and/or require the use of internal fixation. We present an application of osteochondral autograft transplantation surgery as a treatment option for focal metacarpal head lesions. An osteochondral plug from the non-weight-bearing articular surface of the knee is transferred and press-fit to resurface a focal metacarpal head defect. The technical pearls and pitfalls are reviewed, and an illustrative case is presented.

Three-Dimensional Analysis of Metacarpal Head Articular Defects Created by Headless Screws.

Objectives: Headless screw fixation used to treat metacarpal neck and metacarpal shaft fractures is gaining popularity. The aim of the study is to determine the proportion of the metacarpal head articular surface that is compromised during retrograde insertion of headless screws. Methods: Metacarpal screw fixation through a metacarpal head starting point was performed using fluoroscopic guidance on 14 metacarpals. Headless compression screws, with a tail diameter of 3.6mm, were used. The specimens were subsequently skeletonized and digitized using a 3-dimensional surface scanner. The articular surface defects created by the screws were then determined using computer software. Screw position in the dorsal aspect of the metacarpal head was expressed as a percentage of the total volar-to-dorsal distance. Results: The 14 metacarpals studied consisted of 2 index, 4 long, 4 ring and 4 small metacarpals, taken from 4 hands. The average total metacarpal head surface area was 284.6 mm2 (range, 151.0-462.2 mm2); the average screw footprint in the metacarpal head was 13.3 mm2 (range, 10.3-17.4 mm2), which compromised a mean of 5.0% (3.0-7.8%) of the total cartilaginous metacarpal head surface area. In the sagittal plane, screw placement was found to lie in the dorsal 37.4% of the metacarpal head (range, 20.7-58.6%). Conclusion: The proportion of the articular surface area injured with retrograde insertion of headless compression screws into the metacarpal head is 5.0%. Screw placement is generally in the dorsal 37% of the metacarpal head.

Open Reduction and External Fixation of a Comminuted Intra-articular Fifth Metacarpal Head Fracture: A Case Report.

Comminuted intra-articular fractures are among the most difficult to fix, with open reduction and internal fixation often being impossible. We report the case of a 15-year-old male who required an open reduction with external fixation after sustaining an extremely comminuted intra-articular fifth metacarpal head fracture of the right hand. The patient presented with swelling localised to the fourth and fifth dorsal metacarpals of the right hand, with radiographs demonstrating an intra-articular fracture with comminution and articular surface depression. Literature surrounding metacarpal head fractures, although scarce, suggests that whilst treatment must be individualised, most osteochondral fractures can be managed via open reduction with internal fixation either via K wires, interfragmentary screws or small headless screws. This case demonstrates that in challenging cases, with limited bone stock and cavities created through reduction of the fracture, fixation can be achieved through K wire with HK2 external fixation. It also highlights the apparent insufficiency in articles specifically detailing potential management options for intra-articular metacarpal fractures and has provided evidence of one potential fixation method.

Unexplored parameters of ulnar nerve in the palm and its clinical implications; A cadaveric study.

OBJECTIVES: Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of ulnar nerve from bony landmarks in the palm. Ulnar nerve is closely related to the pisiform and hook of hamate which act as important landmarks. METHODS: The study was conducted on 30 formalin fixed adult hand specimens in the department of Anatomy. Various measurements related to the ulnar nerve in the palm were taken using a divider and Vernier Calipers and the values were tabulated after obtaining the mean and standard deviation. RESULTS: The average distance seen in the hand specimens [n = 30] from pisiform to the division of ulnar nerve into superficial and deep branch was 0.89 ± 0.25cm and the distance between pisiform bone up to the division of superficial branch of ulnar nerve into proper and common digital branches was 1.36 ± 0.59 cm. The average distance from the origin of proper digital branch of ulnar nerve to the head of fifth metacarpal bone was 5.25 ± 0.59 cm. The length of common digital branch of ulnar nerve from its origin to division into 2 sensory branches was 4.31 ± 1.09 cm. CONCLUSION: This study provides the metric parameters of the ulnar nerve in the hand from its significant bony landmarks which should be kept in mind during surgical procedures to minimize the incidence of injury to its branches. It would assist the orthopedic surgeon in the treatment of ulnar nerve compression in the Guyon's canal.

Horizontal (Transverse) Intraarticular Metacarpal Head Fracture in a Young Adult.

Metacarpal head fractures are rare injuries that usually occur during trauma. These fractures are classified into 10 groups, with horizontal (transverse) being the rarest type of fractures. To our knowledge, very few cases have been reported in the literature to date. Here, we present the case of a 21-year-old male who sustained multiple ipsilateral hand injuries accompanied by a horizontal (transverse) fracture of the fourth metacarpal. He underwent open reduction and fixation with Kirschner wires followed by intensive rehabilitation. He finally regained complete active range of motion and grip strength three months after the operation. However, at nine months postoperatively, he developed avascular necrosis, which was asymptomatic and did not need any intervention. Therefore, it is important to maintain a high index of suspicion for possible complications and follow patients regularly, probably even for as long as 12 months after the initial injury.

Diagnosis and treatment of a closed and inverted metacarpal head fracture.

This case report documents a rare inversion of a closed metacarpal head fracture in the setting of polytrauma. Although rare, hemispherical articular bones can fracture and rotate 180°. Because of the symmetry of the bone and the rarity of an inverted, metacarpal head fracture, a delay in diagnosis and subsequent treatment can occur, which can lead to a poor outcome. This is particularly true in the setting of polytrauma. A 38-year-old male, polytrauma patient presented to the emergency department (ED) after falling off a bridge and being struck by an oncoming vehicle. He presented with multiple surgical fractures of the upper and lower extremities as well as his pelvis. Three days after he was brought to the ED, x-rays were performed of his painful left hand, which revealed an extra-articular third metacarpal head fracture, for which he underwent open reduction of the closed fracture. Both collateral ligaments were intact and the head fragment had inverted within the constraints of these ligaments. Some of the ligament and capsular tissue remained attached to the head fragment along the radial and ulnar margins but was otherwise entirely covered with cartilage. The reduction maneuver was difficult but after the reduction was achieved, the fracture appeared stable and no internal fixation was used. Post reduction, the injury was splinted for 2 weeks and then early motion was allowed. The fracture has since healed, and the patient has attained near-full function of the finger and joint.

A Case of Coronal Intra-articular and Epiphyseal Fractures of the Metacarpal Head in Early Adolescence.

Intra-articular metacarpal head fracture is relatively rare. We report a case of coronal intra-articular and epiphyseal fractures of Salter-Harris type IV injury in the metacarpal head of the index finger. Surgery was performed by a dorsal approach. The volar fragment that was displaced proximally was gently reduced while bending the metacarpophalangeal (MP) joint, and it was fixed with cortical screws inserted proximal to the articular cartilage facilitating early rehabilitation. We consider the mechanism of injury to be a force applied from the distal phalanx that was transmitted unevenly to the volar side when the MP joint was slightly flexed. A three-dimensional computed tomography scan was useful in making the precise diagnosis, confirming the fracture pattern and planning fixation of the fracture.

Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study.

Objectives: This study aims to develop an automatic deep-learning algorithm, which is based on Convolutional Neural Networks (CNNs), for ultrasound informative-image selection of hyaline cartilage at metacarpal head level. The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard. Methods: The study was divided into two steps. In the first one, an automatic deep-learning algorithm for image selection was developed using 1,600 ultrasound (US) images of the metacarpal head cartilage (MHC) acquired in 40 healthy subjects using a very high-frequency probe (up to 22 MHz). The algorithm task was to identify US images defined informative as they show enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage. The algorithm relied on VGG16 CNN, which was fine-tuned to classify US images in informative and non-informative ones. A repeated leave-four-subject out cross-validation was performed using the expert sonographer assessment as gold-standard. In the second step, the expert assessed the algorithm and the beginner sonographers' ability to obtain US informative images of the MHC. Results: The VGG16 CNN showed excellent performance in the first step, with a mean area (AUC) under the receiver operating characteristic curve, computed among the 10 models obtained from cross-validation, of 0.99 ± 0.01. The model that reached the best AUC on the testing set, which we named "MHC identifier 1," was then evaluated by the expert sonographer. The agreement between the algorithm, and the expert sonographer was almost perfect [Cohen's kappa: 0.84 (95% confidence interval: 0.71-0.98)], whereas the agreement between the expert and the beginner sonographers using conventional assessment was moderate [Cohen's kappa: 0.63 (95% confidence interval: 0.49-0.76)]. The conventional obtainment of US images by beginner sonographers required 6.0 ± 1.0 min, whereas US videoclip acquisition by a beginner sonographer lasted only 2.0 ± 0.8 min. Conclusion: This study paves the way for the automatic identification of informative US images for assessing MHC. This may redefine the US reliability in the evaluation of MHC integrity, especially in terms of intrareader reliability and may support beginner sonographers during US training.

Treatment of Locking of the Metacarpophalangeal Joint of the Thumb.

Locking of the thumb metacarpophalangeal joint is a relatively rare condition. We report successful treatment in 11 cases of locking of the thumb. Ten patients were diagnosed at an average of 3.2 days (range: 0-21 days) from the injury onset, whereas one patient was diagnosed at 4 months from the injury. Seven of 11 cases underwent successful manual reduction, whereas the other four cases required surgical treatment. Among the surgically treated cases, all cases had a sharp prominent of the radial condyle of the metacarpal head. Therefore, this case series showed 1 chronic case and 4 of 10 cases with a nonround shape of metacarpal heads requiring open reduction.

Fracture of first metacarpal head: A rare case presentation and review of literature.

Fractures around the head and neck region of first metacarpal are unusual and have not been reported in literature. We report a case of fracture of head of first metacarpal with intact articular surface, treated with open reduction and internal fixation, with a follow up period of six months. Surgical procedure, intraoperative difficulties in obtaining reduction and steps to overcome them have been described. Satisfactory functional outcomes can be achieved using stable internal fixation with minimal hardware and early mobilization in first metacarpal head fractures.

Osteochondroses of the bilateral metacarpal heads: Dieterich disease. A case report with review of the literature.

Osteochondroses is a well-known entity and typically affecting immature skeleton with few common locations involved are femoral head epiphysis, tibial tubercle apophysis, calcaneal apophysis, humeral capitellum and anterior vertebral end plates. We report a rare case of osteochondroses showing avascular necrosis involving metacarpal heads known as Dieterich disease, involving the head of the third metacarpal and probably the first case with a history of rock climbing as an etiology. Chronic repetitive microtrauma plays a significant role in the disease, as is seen in our patient. Imaging plays a crucial role in diagnosing, as well as monitoring progress, with MRI being a critical modality. The fact that this entity is rare does not necessarily make it difficult to detect. It may be clinical underdiagnosed due to lack of familiarity with this entity and radiographic findings may be subtle or inapparent. Bone scan is likely sensitive but not specific. MRI also likely has a role for early detection. This article is written with educational intent for the reader for the benefit of the patients with this rare disease.

Iatrogenic displacement of the metacarpal head of the index finger while attempting closed reduction of a complex dorsal metacarpophalangeal joint dislocation.

We describe the case of an 84-year-old woman with a dorsal dislocation of the metacarpophalangeal (MCP) joint of the left index finger. Closed reduction was performed at an orthopaedic clinic which led to an iatrogenic complete displacement of the second metacarpal head to the volar side. Because reduction was impossible, surgery was performed. The metacarpal head was reduced and fixed with two headless intramedullary screws. Careless attempting a closed reduction of the complex dorsal MCP joint dislocation might be contraindicated in elderly patients with bone fragility.

Pyrolytic Carbon Hemiarthroplasty for Avascular Necrosis of the Metacarpal Head: A Case Report.

Avascular necrosis of the metacarpal head is a rare entity. Surgical interventions, such as curettage, bone-grafting, and osteotomy, have been reported in symptomatic patients. We present a patient who underwent pyrolytic carbon hemiarthroplasty of the metacarpal head and had satisfactory outcomes at 1-year follow-up.

Pathologic Fractures Extended to the Metacarpal Head Related with Enchondromas at the Metacarpal Neck.

We present two cases of pathologic fractures extended to the metacarpal head related with enchondromas at the metacarpal neck treated by surgery. The timing of surgery varied between the two cases. The first was operated without delay, using tumor curettage and ß-TCP (tricalcium phosphate) packing in the cavity, followed by internal fixation of the fracture using a screw and Kirshner wires. In the second case, tumor curettage and ß-TCP packing was performed after fracture union. Favorable clinical outcomes were obtained for both cases.