[Effect of implants in the metacarpal head and proximal phalanx on mobility of the metacarpophalangeal joint. An anatomic study].
Percutaneous application of Kirschner wires, fixator pins, or other implants near the metacarpophalangeal joint may lead to postoperative disability of movement with subsequent joint stiffness. To determine the best location for the application of implants into the metacarpal head and the basis of the proximal phalanx, 57 Kirschner wires were introduced into the metacarpal head and into the bases of the proximal phalanx and the resulting stiffness has been measured. Kirschner wires inserted at the level of the dorsal tubercle or proximal to the tubercle, do not lead to a noteworthy stiffness. Whenever possible, this tubercle should be taken as the distal border for inserting implants. If the position of the fracture line makes it necessary to implant wires into the metacarpal head itself, a more dorsal application is preferable. If a palmar placement cannot be avoided, the implantation should be done in neutral position of the metacarpophalangeal joint, because a transfixation of the tense collateral ligament in flexion leads to a maximum of postoperative stiffness. The application of wires into the basis of the proximal phalanx does not influence the range of movement of the metacarpophalangeal joint.
Gausepohl
T
T
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie des St. Vinzenz-Hospitals, Köln.
Pennig
D
D
Koebke
J
J
Thiel
J
J
D001696:Biomechanical Phenomena; D001864:Bone Wires; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology*