Manejo quirúrgico de las fracturas de las falanges y los metatarsianos

Una revisión actualizada

  • Alberto González Sayago -
Palabras clave: Osteosístesis, Fractura, mano, falange, metacarpiano

Resumen

Las fracturas de falanges y metacarpianos son de las más frecuentes. Las posibilidades quirúrgicas son muy variadas, como también los distintos tipos de fracturas. La dificultad de poder comparar distintos tipos de fractura entre sí hace complejo el análisis del mejor tipo de tratamiento quirúrgico. Objetivo: Realizar una revisión actualizada de los distintos manejos quirúrgicos para el tratamiento de las fracturas de falanges y metacarpianos en la mano para decidir el mejor tratamiento para cada tipo de fractura. Materiales y métodos: Se ha realizado una búsqueda no sistemática en PubMed, Scopus y Embase para localizar artículos sobre manejo quirúrgico de fracturas de falanges y metacarpianos, estudiando todos las zonas y tipos de fractura, así como sus posibilidades quirúrgicas. Resultados: De un total de 56 artículos publicados en los últimos 10 años, se seleccionaron 30 artículos, tras aplicar los criterios de selección y exclusión. Lamayoría fueron revisiones bibliográficas; el resto, estudios retrospectivos y prospectivos, series de casos y 2 ensayos clínicos controlados aleatorizados. Conclusiones: Las posibilidades quirúrgicas para cada zona y tipo de fractura en falanges y metacarpianos son tremendamente variables, actualmente no existe evidencia suficiente que permita establecer el mejor tratamiento para cada fractura. Hacen falta ensayos clínicos de alta calidad.

Citas

Dean BJF, Little C. Fractures of the metacarpals and phalanges. J Orthop Trauma. 2010; 25(1): 43-56. https://doi.org/10.1016/j.mporth.2010.10.008

Unnikrishnam PN, Bhalaik V. Management of acute fracture of the hand. J Orthop Trauma. 2014; 25(4): 205-113. https://www.orthopaedicsandtraumajournal.co.uk/article/S1877-1327(14)00067-0/abstract

Cheah A E-J, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations. J Hand Surg [Am]. 2016; 41(6): 712-22. https://www.ncbi.nlm.nih.gov/pubmed/27113910

Stern PJ. Management of fractures of the hand over the last 25 years. J Hand Surg [Am]. 2000; 25(5): 817-23. https://www.ncbi.nlm.nih.gov/pubmed/11040296

Taghinia AH, Talbot SG. Phalangeal and Metacarpal Fractures. Clin Plastic Surg. 2019; 46(3): 415-23. https://www.ncbi.nlm.nih.gov/pubmed/31103086

Ruchelsman DE, Mugdal CS, Jupiter JB. The Role of Locking Technology in the Hand. Hand Clin. 2010; 26(3): 307–19.https://www.ncbi.nlm.nih.gov/pubmed/20670796

Jones NJ, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg. 2012; 130(5):722e-36e. https://www.ncbi.nlm.nih.gov/pubmed/23096627

Kamath JB, Vardhan H, Naik DM, Bharadwaj P, Menezes RJ, Sayoojianadhan BP. Modified Bone Tie: A New Method to Achieve Interfragmentary Compression in Unstable Oblique Metacarpal and Phalangeal Fractures. Tech Hand Surg. 2012;16(1): 42-4. https://www.ncbi.nlm.nih.gov/pubmed/22411118

Farias E, Lichterman M, Yuhas M, Thirkannad SM. Interlocking K Wires Followed by Immediate Mobilization for Fractures of the Hand. Tech Hand Up Extrem Surg. 2018; 22(1): 3-9. https://www.ncbi.nlm.nih.gov/pubmed/29466278

Wong VW, Higgins JP. Evidence-Based Medicine: Management of Metacarpal Fractures. Plast Reconstr Surg. 2017; 140(1):140ee-51e. https://www.ncbi.nlm.nih.gov/pubmed/28654615

Bhatt RA, Schmidt S, Stang F. Methods and Pitfalls in Treatment of Fractures in the Digits. Clin Plastic Surg. 2014; 41(3): 429-50. https://www.ncbi.nlm.nih.gov/pubmed/24996463

Lögters TT, Lee HH, Gehrmann S, Windolf J, Kaufmann RA. Proximal Phalanx Fracture Management. Hand [NY]. 2018; 13(4):376-83. https://www.ncbi.nlm.nih.gov/pubmed/29078727

Takigami H, Sakano H. Internal fixation with the low profile plate system compared with Kirschner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures. Hand Surg. 2010; 15(1): 1-6. https://www.ncbi.nlm.nih.gov/pubmed/20422719

Zhang X, Yu Y, Shao X, Dhawan V, Du W. A randomized comparison of bone-cement K-wire fixation vs plate fixation of shaft fractures of proximal phalanges. Phys Sportsmed. 2019; 47(2) 189-98. https://www.ncbi.nlm.nih.gov/pubmed/30408421

Shimizu T, Omokawa S, Akahane M, Murata K, Nakano K, Kawamura K, et al. Predictors of the postoperative range of finger motion for comminutedperiarticular metacarpal and phalangeal fractures treated with a titanium plate. Injury. 2012; 43(6): 940-5. https://www.ncbi.nlm.nih.gov/pubmed/22459897

Waris E, Ninkovic M, Harpf C, Ninkovic M, Ashammakhi N. Self-Reinforced Bioabsorbable Miniplates for Skeletal Fixation in Complex Hand Injury: Three Case Reports. J Hand Surg [Am]. 2004; 29(3): 452-7. https://www.ncbi.nlm.nih.gov/pubmed/15140489

Simón-Pérez C, Rodríguez-Mateos JI, Martín-Ferrero MA. Percutaneous screw fixation in hand fractures. Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 2009; 53(5): 320-24. https://www.sciencedirect.com/science/article/abs/pii/S1988885609701889

Dailiana Z, Agorastakis D. Varitimidis S, Bargiotas K, Roidis N. Malizos KN. Use of a Mini-External Fixator for the Treatment of Hand Fractures. J Hand Surg [Am]. 2009; 34(4): 630–36. https://www.ncbi.nlm.nih.gov/pubmed/19345865

Beck CM, Horesh E, Taub PJ. Intramedullary Screw Fixation of Metacarpal Fractures Results in Excellent Functional Outcomes: A Literature Review. Plast. Reconstr. Surg. 2019; 143(4): 1111-8. https://www.ncbi.nlm.nih.gov/pubmed/30676504

Del Piñal F, Moraleda E, Rúas JS, de Piero GH, Cerezal L. Minimally Invasive Fixation of Fractures of the Phalanges and Metacarpals With Intramedullary Cannulated Headless Compression Screws. J Hand Surg [Am]. 2015; 40(4): 692-700. https://www.ncbi.nlm.nih.gov/pubmed/25661294

Baçar H. Baçar B. Baççi O, Topkar OS, Erol B, Tetik C. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with miniplate plus screw or screw only. Arch Orthop Trauma Surg. 2015;135(4): 499-504. https://www.ncbi.nlm.nih.gov/pubmed/25682110

El-Saeed M, Sallam A, Radwan M, Metwally A. Kirschner Wires Versus Titaniun Plates and Screw in management of Unstable Phalangeal Fractures: A Randomized, Controlled Clinical Trial. J Hand Surg [Am]. 2019; 44(12):1991.e1-e9. https://www.ncbi.nlm.nih.gov/pubmed/30803743

Köse A, Topal M, Engin MC, Çencan A, Dinçer R, Baran T. Comparison of low‑profile plate‑screw and Kirschner‑wire osteosynthesis outcomes in extra‑articular unstable proximal phalangeal fractures. Eur J Orthop Surg Traumatol. 2019; 29(3): 597-604. https://www.ncbi.nlm.nih.gov/pubmed/30426217

Itadera e, Yamazaki T. Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures. J Hand Surg [Asian Pac]. 2017; 22(1): 35-8. https://www.ncbi.nlm.nih.gov/pubmed/28205482

Carrera Casal O, Rivera Vegas MJ, Estefanía Díez ME, García Cano P, Maya González JA, Nevado Sánchez E. Percutaneous Osteosynthesis with Headless Cannulated Screws in the Treatment of Metacarpal and Proximal and Middle Phalanxes Fractures of the Hand. Rev Iberam Cir Mano. 2018; 46:117–25. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0038-1676080

Poggetti A, Nucci AN, Giesen T, Calcagni M, Marchetti S, Lisanti M. Percutaneous Intramedullary Headless Screw Fixation and Wide-Awake Anesthesia to Treat Metacarpal Fractures: Early Results in 25 Patients. J Hand Microsurg. 2018; 10(1): 16-21. https://www.ncbi.nlm.nih.gov/pubmed/29706731

Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws. J Hand Microsurg. 2016; 8(3):134–9. https://www.ncbi.nlm.nih.gov/pubmed/27999455

Al-Qattan, M. M., Al-Zahrani, K., Al-Arfaj, N., & Shanawani, B. (2010). A modified technique of dental wire fixation for spiral/oblique metacarpal and phalangeal fractures of the fingers. J Hand Surg [Eu]. 2010; 35(4): 325–6. https://www.ncbi.nlm.nih.gov/pubmed/20444792

Fischborn T, Beckenbaur D, Held M, Daigeler A, Medved F. Analysis of Operative Techniques of Fractures of the First Metacarpal Base. Ann Plast Surg. 2018; 80(5): 507-14. https://www.ncbi.nlm.nih.gov/pubmed/29319570

Zhang B, Hu P, Yu K, Bai J, Tian D, Zhang G, et al. Comparison of AO Titanium Locking Plate and Screw Fixation versus Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures. Orthop Surg. 2016; 8(3): 316-22. https://www.ncbi.nlm.nih.gov/pubmed/27627714

Publicado
2020-07-31
Sección
Artículos de Revisión