A New Prototype of Dynamic External Fixator for the Metacarpophalangeal Joint
Francesco Kostoris, MD1; Andrea Poggetti, MD2; Francesco Addevico, MD2; Luigi Murena MD1
1Trieste University, Trieste, Italy; 2Pisa University, Pisa, Italy
Introduction Intraarticular fractures of the metacarpophalangeal joint are relative infrequent. If the articular surface involved is less than 20% some authors suggest a nonoperative treatment with a buddy taping. If the amount of the articular surface involved is more than 20% surgical treatment should be considered. ORIF has proven to be effective but is often complicated by stifness. The purpose of our study is to present a new prototype of dynamic external fixator created with K wires that could allow immediate active mobilization. Materials and methods We describe a new frame made by K wires that provides a constant distraction during flexion and extension of the metacarpophalangeal joint. This frame was implanted in three specimens. We studied the effectiveness of this device in different patterns of fracture: fracture of the base of the proximal phalanx and in the fracture of the metacarpal neck. Results Acting on the tendon in order to simulate active ROM, a 45° of flexion was possible; passively a wider range of motion was obtained. We studied the effectiveness of this device under fluoroscopy: a constant distraction was provided both in flexion and in extension making possible to apply the ligamentotaxis even to the metacarpophalangeal joint. The main indication of this device is to manage intraarticular fractures, even multifragmentary, of the metacarpophalangeal joint that could be treated with ligamentotaxis. In addition this device could be useful even in the metacarpal neck fractures that are treated with retrograde K wires: the frame allows early movement without compromising stability. Conclusion We created a frame that is simple and fast to implant for the surgeon. It is cheap because is made by simple materials such as K wires. The results are encouraging; this device could allow early active mobilization even in the metacarpophalangeal joint.
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