Search Results (22)

Background/Objectives: Intramedullary headless compression screw (IMHCS) fixation has emerged as a minimally invasive and biomechanically robust method for treating metacarpal and proximal phalangeal fractures. While the clinical outcomes are generally favorable, the impact of anatomical fracture reduction on postoperative function has not been systematically examined. Methods: We retrospectively analyzed 69 patients (41 metacarpal, 28 proximal phalanx) treated with IMHCSs between June 2020 and March 2025. Fractures were classified radiographically as reduced or non-reduced. Functional outcomes were assessed using the Total Active Motion (TAM) scoring system. The association between the reduction quality and TAM outcome was analyzed separately for metacarpal and proximal phalangeal fractures using the Fisher–Freeman–Halton exact test. Results: All fractures achieved radiographic union. In the metacarpal fractures, 90% of the patients attained good-to-excellent TAM scores, with no statistically significant association between the reduction quality and functional outcome (p = 0.1303). In contrast, for the proximal phalangeal fractures, anatomical reduction was significantly associated with superior TAM outcomes (p = 0.0014; Cohen’s w = 0.802). The postoperative radiographs in this group revealed smooth dorsal cortical alignment in the patients with good outcomes, suggesting preserved tendon gliding surfaces. Conclusions: Anatomical fracture reduction significantly predicts postoperative function in proximal phalangeal fractures treated with IMHCSs. In contrast, metacarpal fractures appear more tolerant of minor malalignment. These findings underscore the importance of achieving cortical continuity in phalangeal fractures to optimize digital biomechanics. A minimal open approach should be considered to ensure proper alignment during IMHCS fixation. Full article

This pilot study evaluated the effectiveness of ice boots in cooling the metacarpal and coronary regions of a horse after training over 8 days (n = 8). Background: While cryotherapy is effective in managing exertional heat illness, stress fractures, and laminitis in horses, conventional methods are often costly and impractical. This pilot study assessed the efficacy of ice boots as an accessible alternative for cooling the metacarpal and coronary regions post-training. Methods: A four-year-old Warmblood mare was trained on a treadmill over 8 days. An ice boot was applied to the right thoracic limb for 20 min post-exercise. Thermographic images were captured at six time points from pre-training to 30 min post-cooling. Mean temperatures in four regions were analyzed using the FLIR Tools software v6.4.18039.1003. Results: Post-training, metacarpal temperatures increased by 10.97 ± 0.46 °C (p = 0.000). Ice boot application reduced metacarpal temperature by 20.27 ± 0.22 °C (p = 0.001) and coronary band temperature by 5.28 ± 0.30 °C (p = 0.001), with altered thermal patterns visible on the imaging. Treated regions returned to baseline within 30 min, while the control limb took 50 min. Conclusions: Ice boots provide rapid, effective cooling and distinctive thermal pattern changes, offering a practical cryotherapy alternative for equine limb care post-training. These initial findings lay the groundwork for larger studies involving more horses under varied conditions, which will be necessary to confirm the results and establish clear guidelines for the clinical use of ice boots in equine practice. Full article

The purpose of this study was to investigate changes in bone trabecular structure during adolescence using the fractal analysis (FA) method on hand–wrist radiographs (HWRs) and to evaluate the relationship of these changes with pubertal growth stages. HWRs of healthy individuals aged 8–18 years were included (N = 600). Pubertal stages were determined by the Fishman method and divided into 10 groups (early puberty [EP], pre-peak [PRPK], peak [PK], post-peak [PTPK], late puberty [LP]). FA was performed using FIJI (ImageJ) software and the BoneJ plugin on circular regions of interest (ROIs) selected from the first metacarpal bone head and distal radius. Image processing steps were applied according to the White and Rudolph method. Differences between groups were statistically evaluated. Fractal dimension (FD) values of the distal radius (RAFAM) and metacarpal bone head (MAFAM) showed significant differences according to pubertal growth stages (p < 0.05). The highest FD value was observed in the LP group, and the lowest FD value was observed in the EP group (except MAFAM in females). FD generally increased from EP to LP in the whole population, but a significant decrease was observed in all groups during the PK period. This decrease was more pronounced in RAFAM of males. These findings suggest a potential decrease of bone mechanical properties in the PK, which is found the be more suitable for orthodontic treatment in the literature. FA on HWRs is a useful and sensitive tool for quantitatively assessing pubertal changes in trabecular bone microarchitecture. The findings demonstrate a significant decrease in FD in both bone regions during the pubertal growth spurt, particularly at the peak period. This may indicate a temporary reduction in bone mechanical strength during this critical stage and could contribute to increased distal radius fracture incidence. Clinically, the relationship between FD and pubertal stages suggests this method could serve as a valuable biomarker in orthodontic treatment planning, allowing for optimized timing of interventions. Furthermore, it may aid in pediatric fracture risk assessment, potentially leading to preventative strategies for high-risk individuals. Full article

Background: acute compartment syndrome (ACS) is an orthopedic emergency characterized by pathological pressure elevation within a confined anatomical space, posing a significant challenge in pediatric patients. ACS affects children in a very limited proportion, particularly involving the upper extremities, and diagnosis is complicated by subtle manifestations compared to adults. Case Presentation: we report on the case of a 5-year-old boy who sustained a crush injury to his right hand, resulting in multiple metacarpal fractures and subsequent ACS. The patient presented with severe pain, hand deformity, and restricted mobility. Radiological evaluation confirmed displaced fractures of multiple metacarpals. Emergency surgical intervention involved six incisions to decompress the dorsal and palmar compartments, release muscles, and decompress the median nerve. Healing involved delayed primary closure monitored every 72 h, resulting in an optimal outcome without complications. Conclusions: pediatric upper extremity ACS is rare, complicating diagnosis and treatment due to limited guidelines. This case underscores the effectiveness of early surgical decompression and delayed primary closure in achieving favorable outcomes. Individualized treatment strategies tailored to anatomical considerations and ACS severity are crucial to optimize patient care in pediatric surgical settings. Full article

Complete fractures of the third metacarpal bone (MC III) diaphysis pose a significant clinical challenge, prompting advanced veterinary medicine to utilize constitutive and biomechanical modeling to better understand bone behavior. This study aims to compare the elastic modulus of the MC III cortical bone, supported by measurements of cortical bone thickness and relative density, across the dorsal, lateral, medial, and palmar aspects of the MC III, as well as to evaluate the cortical bone’s response to compressive forces applied in different directions. Given the bone structure can exhibit sex-related differences, MC III bones were isolated from six equine cadaver limbs collected exclusively from mares and imaged using computed tomography (CT) to measure thickness and density. Cortical bone samples were collected from the four aspects of the MC III and subjected to mechanical testing followed by the elastic modulus calculation. Bone thickness and elastic modulus varied across the MC III aspects. Thinner cortical bone on the palmar aspect coincided with a lower sample reaction force-based elastic modulus in the externo-internal direction and a lower axial compression force elastic modulus in the proximo-distal direction. Regardless of the MC III aspect, the cortical bone demonstrated greater resistance to compressive forces when loaded in the vertical plane than in the horizontal plane. The returning of different values in mechanical tests depending on the direction of loading may be attributed to the anisotropic behavior of the cortical bone, which may implicate the increased risk of complete fractures of the MC III diaphysis due to a kick from another horse or a fall, rather than from training or competition-related overload. Full article

Though circular exercise is commonly used in equestrian disciplines, it may be at the detriment of horses’ musculoskeletal system. To investigate the effects of circular exercise on bone and joint health, 42 lambs were randomly assigned to a non-exercised control, straight-line, small circle, or large circle exercise regime at a slow (1.3 m/s) or fast (2.0 m/s) speed for 12 wk. Blood samples were taken biweekly. Animals were humanely euthanized upon study completion, and the fused third and fourth metacarpals were collected for biomechanical testing and bone density analysis. Fast groups were found to have more bone formation and less resorption activity than slow groups as evidenced by serum biomarker concentrations (p < 0.05). Sheep in the large fast group tended to have greater flexural rigidity and fracture force for the outside leg compared to the inside leg (p < 0.1). Sheep in the small slow group tended to have increased bone mineral density of the outside leg compared to the inside leg, whereas the opposite occurred in the large slow group (p < 0.1). These results provide further evidence for potential asymmetric musculoskeletal adaptations to circular exercise while emphasizing the importance of speed as a positive influence on bone metabolism and strength. Full article

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine. Full article

Background/Objectives: Most metacarpal fractures are isolated, simple, closed, and stable fractures and located distally. They are often caused by accidental falls, strikes by humans, by objects or traffic accidents. The majority can be treated conservatively. When unstable, angulated, malrotated or shortened, a surgical fixation of these frequent fractures is needed. To treat simple, spiral, distal or shaft fractures, intramedullary Kirschner wiring (KW) or intramedullary compression screws (ISs) are used. We wanted to compare the outcomes of those two treatments. Methods: In a retrospective study we analyzed the prospectively collected data of our hospital on the indication factors and outcome factors of selected patients with simple or spiral, distal or shaft metacarpal fractures of the second to fifth finger. Indication factors were sex, age, profession, hand dominance, comorbidities, metacarpal finger number, total active range of motion (TAM), rotation, soft tissue damage, localization, articular involvement, fracture type, dislocation and axial shortening. Outcome factors were TAM, rotation, splint time, return to work, bone healing and complications. Results: Out of 750 patients, 59 fractures could be included in this study, containing 34 in the KW Group and 25 in the IS Group. Only fracture localization and fracture type were significantly different in the two groups, with more shaft and spiral fractures in the IS Group. The primary outcome of TAM and rotation as well as the secondary outcome of splint time, return to work, bone healing and complication rates showed no significant difference. Only a difference in mean follow-up time was seen. Conclusions: Intramedullary screw fixation seems a valid alternative to KW fixation for certain fracture types regarding active range of motion and rotation after treatment, splint time, bone healing and return to work time. Only the tendency of an earlier return to work and a higher rate of full TAM after treatment was seen in favor of intramedullary screws. Full article

Horses have been companions of people for thousands of years. Areas in which humans use these animals include, for example, transport, participation in sports competitions, or during rehabilitation (hippotherapy). Unfortunately, injuries such as lower limb fracture very often require euthanasia due to the significant difficulties in conducting fracture therapy/repair. Therefore, there are still many possibilities for the improvement of existing treatments. The aim of the study was to conduct a numerical analysis enabling the prediction of bone union of the third metacarpal bone of a horse. The loading conditions and type of fracture were based on a pony weighing 120 kg; however, research on a live animal was not the purpose of this study. Numerical studies were carried out for three different methods of stabilization using bone plates in the Ansys program (lateral, anterior, and lateral–anterior stabilization). An algorithm based on the Carter model was used to predict bone union, while linear-coupled models were used to describe the behaviour of materials. The authors also performed dynamic analyses in the Abaqus/Explicit program to determine the maximum speed at which the horse could move so that the fracture would not deepen. For dynamic analyses, the authors used nonlinear models—Johnson–Cook in the case of the 316L surgical steel material and cortical bone. Material failure was described using the Johnson–Cook failure model for steel and the limit strain model for cortical bone. A series of numerical simulations allowed to determine the direction of bone union building, and the most favourable case of stabilization was determined. Full article

Malunion of thumb and finger fractures causes problems in the cosmetic and functional aspects of the hand. Malunion of phalangeal fractures usually manifests as a combination of rotational deformities in the coronal, sagittal, and transverse planes, and corrective osteotomy is performed on the planes that cause these problems. Quantification of the deformity is essential for precise osteotomy and is difficult to perform in the transverse plane, even with radiography or computed tomography. Thus, we developed a technique called linkage simulation for the quantitative measurement of rotational deformities for surgical planning. In this procedure, finger extension and flexion can be simulated based on the predicted rotational axis of the joint, which is useful for determining the appropriate correction. Furthermore, by performing a reduction simulation in the software, it is possible to simulate the surgery and predict the postoperative results. This paper reports the details of this technique. Full article

The aim of this study was to assess surgical treatment in metacarpal shaft fractures of the second to fifth ray to determine the functional outcomes and complications in open reduction and internal fixation (ORIF) versus closed reduction and internal fixation (CRIF). This was a retrospective study that included patients with metacarpal shaft fractures of the second to fifth rays who were treated surgically between 1 January 2007 and 31 December 2019. Functional outcomes were scored using the QuickDASH and Eq5D score. A total of 231 treated patients were included. Single fractures were seen in 180 patients, and multiple fractures in 51 patients. ORIF was applied in 141 patients and CRIF in 90 patients. The functional outcomes were not significantly different between the groups. Complications were found in 41 (29%) of the ORIF patients and 15 (17%) of the CRIF patients. The functional outcomes after single or multiple metacarpal shaft fractures were similar in the ORIF and CRIF patients. ORIF showed significantly more complications, such as functional impairment and infections and a higher reoperation rate. In conclusion, CRIF is as safe as ORIF for the surgical treatment of metacarpal shaft fractures in terms of its functional outcome and slightly preferable due to its lower complication rate. Full article

Background and Objectives: Since the neck is the weakest part of the metacarpals, the most common metacarpal fracture is a neck fracture, a type which accounts for 38% of all hand fractures. Such fractures can be fixed using a variety of conventional techniques, including intramedullary pinning and K-wire pinning. However, conventional techniques involve complications, such as angulation, stiffness, and rotational deformity. The purpose of this study was to compare the usefulness of our new technique, combined intramedullary pinning with K-wire pinning (IPKP), with those of intramedullary pinning (IP) and K-wire pinning (KP). Materials and Methods: This was a single-center, randomized controlled trial conducted between January 2005 and April 2023. A total of 158 patients with acute displaced fractures of the fifth-metacarpal neck were randomly assigned to either the IPKP group (n = 48), the KP group (n = 60), or the IP group (n = 50). We radiographically evaluated angulation and shortening in three visits: pre-operatively, post-operatively, and at a 1-year follow-up. We clinically evaluated the ranges of motion and Quick-DASH scores to assess daily living performance and the cosmetic scores, using the SBSES score, to assess patients’ satisfaction with their cosmetic outcomes. Results: The IPKP group was superior to the KP group and the IP group regarding radiographical and clinical assessments at the 1-year follow-up visit. The angulation was 15.7° (±7.7) in the KP group, 17.0° (±5.9) in the IP group, and 12.6° (±2.5) in the IPKP group (p < 0.001) at the 1-year follow-up visit. The shortening was 0.9 mm (±0.3) in the KP group, 1.4 mm (±0.2) in the IP group, and 0.4 mm (±0.1) in the IPKP group (m < 0.001) at the 1-year follow-up visit. The TAM was 272.6° (±17.5) in the KP group, 271.1° (±18.0) in the IP group, and 274.1° (±14.9) in the IPKP group (p = 0.42). Four patients (6.6%) in the KP group and two patients (4%) in the IP group were reported as having stiffness, while no patients were found to have stiffness in the IPKP group. The average Quick-DASH score was 2.3 (±0.5) in the KP group, 2.5 (±0.4) in the IP group, and 1.9 (±0.4) in the IPKP group (p > 0.05). The average cosmetic score was 3.7 (±1.2) in the KP group, 3.8 (±0.9) in the IP group, and 4.7 (±0.8) in the IPKP group (p < 0.001). A complication involving nonunion occurred in one case (1.6%) in the KP group, while there were three cases (6%) of rotational deformity in the IP groups. Conclusions: With the IPKP technique, accurate reduction can be achieved to improve hand function and cosmetic outcomes. Full article

Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological findings were scored and compared between locations with and without fissures on CT. Microscopic examination identified 114/291 locations with fissures. The diagnostic sensitivity and specificity were 88.5% and 61.3% for CBCT, 84.1% and 72.3% for FBCT, and 43.6% and 85.2% for MRI. Four types of imaging features of fissures were characterised on CT: (1) CBCT/FBCT hypoattenuating linear defects, (2) CBCT/FBCT striated hypoattenuated lines, (3) CBCT/FBCT subchondral irregularity, and (4) CBCT striated hypoattenuating lines and FBCT subchondral irregularity. Fissures on MRI appeared as subchondral bone hypo-/hyperintense defects. Microscopic scores of subchondral bone sclerosis, microcracks, and collapse were significantly higher in locations with CT-identified fissures. All imaging modalities were able to identify fissures. Fissures identified on CT were associated with histopathology of fatigue injuries. Full article

Background and Objectives: The expedient resolution of postoperative soft tissue edema is particularly important in hand surgery. Prolonged edema and pain become an obstacle to postoperative rehabilitation, delay return to daily life, and in severe cases, lead to a permanent decrease in range of motion. Based on the common physiology between postoperative hand swelling and complex regional pain syndrome (CRPS), we sought to determine if postoperative mannitol and steroid administration to multiple metacarpal bone fracture patients effectively reduces hand swelling and pain and is beneficial for hand rehabilitation. Materials and Methods: From March 2015 to February 2019, 21 patients who received closed pinning for multiple metacarpal fractures were included in a retrospective cohort study. The control group (n = 11) underwent a routine recovery, while the treatment group (n = 10) received dexamethasone and mannitol injections for five days postoperatively. Serial changes in the degree of pain and fingertip-to-palm distance (FPD) were measured in both groups. The duration from surgery to the initiation of rehabilitation and time to full grip was also compared. Results: Compared to the control, the treatment group showed a faster alleviation of pain scores from the postoperative fifth day (2.91 versus 1.80, p = 0.013), and faster recovery of FPD from postoperative two weeks (3.27 versus 1.90, p = 0.002). Time to physical therapy initiation (6.73 versus 3.80 days, p = 0.002) and full grip achievement (42.46 versus 32.70 days, p = 0.002) were also faster in the treatment group. Conclusions: The steroid-mannitol combination treatment for multiple metacarpal bone fracture patients in the acute postoperative phase promoted the reduction of hand edema and pain, leading to the earlier initiation of physical therapy, rapid improvement in joint motion, and faster achievement of full grip. Full article

Proximal sesamoid bone (PSB) fracture is the leading cause of fatal musculoskeletal injury in Thoroughbred racehorses in Hong Kong and the US. Efforts are underway to investigate diagnostic modalities that could help identify racehorses at increased risk of fracture; however, features associated with PSB fracture risk are still poorly understood. The objectives of this study were to (1) investigate third metacarpal (MC3) and PSB density and mineral content using dual-energy X-ray absorptiometry (DXA), computed tomography (CT), Raman spectroscopy, and ash fraction measurements, and (2) investigate PSB quality and metacarpophalangeal joint (MCPJ) pathology using Raman spectroscopy and CT. Forelimbs were collected from 29 Thoroughbred racehorse cadavers (n = 14 PSB fracture, n = 15 control) for DXA and CT imaging, and PSBs were sectioned for Raman spectroscopy and ash fraction measurements. Bone mineral density (BMD) was greater in MC3 condyles and PSBs of horses with more high-speed furlongs. MCPJ pathology, including palmar osteochondral disease (POD), MC3 condylar sclerosis, and MC3 subchondral lysis were greater in horses with more high-speed furlongs. There were no differences in BMD or Raman parameters between fracture and control groups; however, Raman spectroscopy and ash fraction measurements revealed regional differences in PSB BMD and tissue composition. Many parameters, including MC3 and PSB bone mineral density, were strongly correlated with total high-speed furlongs. Full article