Page 184 - Read Online

Bhandari et al. Metacarpal angulations

angulation, there was an increase in tendon excursion, Study conception and design; acquisition, analysis
tendon load, and work required for flexion. Thus, and interpretation of data: C. Sathega, F. Aguilar, L.
returning the metacarpal to normal alignment is Vicentela, E. Galvis
imperative. Drafting of manuscript and critical revision: E. Galvis

In any curved long bone, the concave surface Financial support and sponsorship
bears the compressive force. When such bones are None.
fractured, the load bearing osteosynthesis should
ideally tackle this concave surface. In the context Conflicts of interest
of metacarpals, the volar surface would be the There are no conflicts of interest.
compression cortex. However, the easily accessible
dorsal surface is preferred for plating, even though
it is not the compression cortex. Metacarpals have Patient consent
attachments of A1 pulleys, and the flexor tendons, Not applicable.
passing under these A1 pulleys, exert a flexion
force on the distal part of the metacarpal. In setting Ethics approval
metacarpal fractures, the flexor tendons can lead to This study obtains approval from the Human Tissue
volar angulation of the distal fragment. This may also Committee.
account for increased incidence of screw loosening
[8]
seen in the distal fragment . Since the angle of the REFERENCES
metacarpals is in the same direction as the flexion
force, it may contribute to volar displacement as well 1. Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of
as screw loosening. metacarpal fractures in the US population. Hand (N Y) 2012;7:426-30.
2. Firoozbakhsh KK, Moneim MS, Howey T, Castaneda E, Pirela-Cruz
In conclusion, the dorsal surface of metacarpals has MA. Comparative fatigue strengths and stabilities of metacarpal
an angulation rather than a curvature. The location of 3. internal fixation techniques. J Hand Surg Am 1993;18:1059-68.
Fricker R, Kastelec M, Nuñez F, Axelrod T. Metacarpals. Available
the angulation is somewhat consistent at the middle of from: https://www2.aofoundation.org/wps/portal/surgery?showPage=
the metacarpal. The degree of angulation is variable. diagnosis&bone=Hand&segment=Metacarpals. [Last accessed on 12
Oct 2017]
DECLARATIONS 4. Braakman M. Normal radiographic angulation in the 4th and 5th
metacarpal: a reference guide. Eur J Radiol 1996;22:38-41.
Acknowledgments 5. Rivlin M, Kim N, Lutsky KF, Beredjiklian PK. Measurement of
the radiographic anatomy of the small and ring metacarpals using
The authors wish to thank the individuals of the computerized tomographic scans. Hand (N Y) 2015;10:756-61.
University of Louisville Willed Body Program who 6. Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in
donated their bodies and tissues for the advancement managing fractures of metacarpal and phalangess. Indian J Plast Surg
of education and research. 2011;44:203-11.
7. Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation
decreases flexor mechanical efficiency in human hands. Plast Reconstr
Authors’ contributions Surg 1997;99:1079-83; discussion 1084-5.
Analysis and interpretation of data, drafting of 8. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal
manuscript and critical revision: L. Bhandari fractures: treatment and complications. Hand (N Y) 2014;9:16-23.

Plastic and Aesthetic Research ¦ Volume 4 ¦ October 20, 2017 177