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Intramedullary Strut Bone Peg for Treating Nonunions of Metacarpal and Phalangeal Fractures Following Failed Plate Fixation: A Case Series
Chih-Hsun Chang, M.D.; Hui-Kuang Huang, M.D.
Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
Introduction Nonunions of metacarpal and phalangeal fractures are uncommon; however, surgical treatment is often required when they cause instability and pain. Nonunion following plate fixation can be particularly challenging, as it requires both bone grafting at the nonunion site and adequate stabilization. In this study, we present a case series of revision surgeries for nonunions of metacarpal and phalangeal fractures following failed plate fixation, utilizing an intramedullary strut bone peg stabilized with intramedullary K-wires.
Materials and Methods From 2012 to 2023, we retrospectively enrolled seven patients with metacarpal or phalangeal fractures that failed to heal after plate fixation. All patients underwent intramedullary strut bone peg grafting at the nonunion site, stabilized with intramedullary K-wire fixation. Pain was assessed using the Visual Analog Scale (VAS) during activity, while functional outcomes were evaluated using the QuickDASH score and total active motion (TAM) of the affected digits.
Results There were seven patients (five males, two females) with three metacarpal and four phalangeal fractures, with a mean age of 38.6 years (range, 21-69) and a mean follow-up period of 15.3 months (range, 12-22). All patients achieved uneventful fracture healing. At the final follow-up, the mean VAS score improved from 5 to 0.7, and the QuickDASH score improved from 54.2 to 17.5. The total active motion (TAM) of the fingers increased from 173 degrees to 211 degrees, while for the thumb, it improved from 50 degrees to 70 degrees
Conclusion This method can achieve a high healing rate, benefiting from the strut bone peg, which increases the intramedullary contact surface to promote bone healing. Additionally, the intramedullary K-wires bypass the previous screw holes and facilitate compression at the fracture site during hand motion.
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