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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Headless screws versus Bouquet in intramedullary fixation in unstable neck metacarpal fractures in active patients: a randomized study

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  • presenting/speaker Marcio Aurelio Aita - Faculdade de Medicina do ABC, São Bernardo do Campo, Brazil
  • Ricardo Kaempf De Oliveira - Hospital Mãe de Deus, Porto Alegre, Brazil
  • Gustavo Mantovani Ruggiero - SP hand center, São Paulo, Brazil
  • Bruno Biondi - Faculdade de Medicina do ABC, São Bernardo do Campo, Brazil
  • Carlos Eduardo Saenz - Hospital do Cajuru, Curitiba, Brazil
  • Pedro J. Delgado - Hospital Universitario HM Monteprincipe, Madrid, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-675

doi: 10.3205/19ifssh0788, urn:nbn:de:0183-19ifssh07882

Published: February 6, 2020

© 2020 Aita et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Despite the high prevalence of unstable neck metacarpals fractures (boxer's fractures) there is still no consensus concerning the preferred method and ideal moment of treatment, especially in active patients where the time or type of management can have a strong psychological impact on the outcomes.

Purpose: To compare ROM (range of motion), working return time, VAS (visual analogue score), quick DASH (disability arm, shoulder and hand) and radiographic outcomes of two methods of definitive internal fixation in active patients in boxer's fractures, operated in the first week.

Methods: prospective, randomized trial, included fifty patients, mean age years (range, 18 - 40 years) were randomized and treated to definitive intramedullary fixation using 2 headless screws (n=20) or bouquet (2 or 3 k-wires) (n=20). The patients were assessed on working time return, ROM (range of motion), patient reported outcome QuickDASH (disability arm and shoulder and hand), VAS (visual analog scale) and radiographic evaluation at 6 months.

Type of study/level of evidence Therapeutic II

Results and Conclusions: At 6 months, there were no differences between the two groups in terms of ranges of motion, postoperative pain (VAS), or Quick DASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet group.

In treatment of the active patients with unstable boxer fractures, headless screws and bouquet fixation prove to be safe and reliable treatment. The outcomes were similar into groups.