Hand Fracture System

Product Overview

The Acumed Hand Fracture System is designed to surgically treat various metacarpal and phalangeal fractures, fusions, and osteotomies and includes five solutions in one tray. Versatile screws, customizable plates, and dedicated instrumentation offer a comprehensive system to streamline the surgical experience.

The system features precontoured standard plates, specialty plates, and Hexalobe MultiScrews. Hexalobe Lag Screws and threaded K-wires are also included for less complicated fractures.

The Acumed Small Bone Fixator and Small Bone Distractor provide external fixation options.

Key Publications

This collection of published literature represents clinical evidence, which along with innovation, education, and quality form Acumed’s foundations of excellence. In addition to citing existing scholarly papers, we conduct ongoing clinical research and use this information for validation and continuous improvement to deliver the greatest value to our customers.

Surgical Outcomes of Fifth Metacarpal Neck Fractures – A Comparative Analysis of Dorsal Plating Versus Tension Band Wiring

Publication Excerpt

“Patients who underwent Dorsal Plating (DP) demonstrated better improvement in fracture angulation, radial-ulnar displacement, Metacarpal (MC) height ratio, and final Range of Motion (ROM) compared to those who underwent Tension Band Wiring (TB).”

Journal Abstract

The purpose of our study is to retrospectively compare the use of tension band (TB) wiring and dorsal plating (DP) for the fixation of fifth metacarpal (MC) neck fractures. A retrospective study of patients who had surgical treatment of 5th MC fractures from 2009 to 2013 was performed. Data including patient demographics, mechanism of injury, preoperative and postoperative pain score, range of motion (ROM), duration of follow-up, and whether implants removed were documented. Three radiological parameters: angulation (in degrees), radial-ulnar displacement (in millimeters) and MC height ratio were measured. There were a total of 84 patients with isolated closed 5th MC neck fractures, of which 41 underwent DP and 43 underwent TB. Patients who underwent DP demonstrated better improvement in fracture angulation, radial-ulnar displacement, MC height ratio, and final ROM compared to those who underwent TB. This study has shown that DP is a viable surgical treatment option for 5th MC neck fractures.

Reference

Wong KP, Hay RA, Tay SC. Surgical outcomes of fifth metacarpal neck fractures – a comparative analysis of dorsal plating versus tension band wiring. Hand Surg. 2015;20(1):99-105 doi: 10.1142/S0218810415500148. PubMed PMID: 25609282.

Comparison of AO Titanium Locking Plate & Screw Fixation vs Anterograde Intramedullary Fixation for Isolated Unstable Metacarpal and Phalangeal Fractures

Publication Excerpt

“Anterograde intramedullary (AIM) fixation, the conventional treatment for metacarpal and phalangeal fractures, has been reported to have many advantages, including minimal soft tissue dissection, smaller skin incision and potentially less tendon irritation. However, these advantages may be outweighed by inferior stability and a greater incidence of complications. In recent years, fixation with Arbeitsgemeinschaft für Osteosynthesefragen (AO) titanium locking plate and screws (ATLPS) has been used to treat unstable metacarpal and phalangeal fractures and has yielded favorable clinical outcomes.”

Journal Abstract

Objective
This study aimed to compare the clinical and radiologic outcomes of AO titanium locking plate and screw (ATLPS) and anterograde intramedullary (AIM) fixation for treating unstable metacarpal and phalangeal fractures.

Methods
Adult patients with isolated fresh unstable metacarpal and phalangeal fractures who met the inclusion criteria were enrolled into this prospective study from July 2013. Patients were divided into ATLPS or AIM groups when they were admitted to our department after considering their work requirement, fracture complexity, and surgeon’s experience and were then treated accordingly. Relevant demographic, clinical and preoperative clinical data were collected and analyzed. Clinical examination and radiograph evaluation were performed 1 week and 1, 3, and 6 months postoperatively. Outcome measures were visual analog scale (VAS) scores for pain, total range of motion (ROM) of the injured digit, Quick Disabilities of the Arm, Shoulder, and Hand scores (Quick-DASH) and grip strength (percentage of the contralateral corresponding digit).

Results
From July 2013 to September 2014, 76 patients were treated by AIM and 71 by ATLPS. Age, sex, time from injury to operation, dominant hand, injury mechanism, fracture location, fracture type, and participant occupation were similar in both groups (P > 0.05). Operations were all performed well and followed by uneventful postoperative functional recoveries. At 3-month follow-up, all clinical outcomes were significantly better in the AIM than ATLPS group (P < 0.05) except for VAS pain scores. However, at 6-month follow-up, the differences were no longer significant, indicating similar results for both types of fixation. Patients in the AIM group developed significantly more complications (P = 0.037). Sick leave was significantly longer in the AIM group (P = 0.02).

Conclusion
AIM outperforms ATLPS in the treatment of unstable metacarpal and phalangeal fractures in the early, but not the later, postoperative period; the latter is associated with significantly more complications. Patients treated by ATLPS require shorter sick leave, which is of particular benefit to workers with specialized manual skills.

Reference

Zhang B, Hu P, Yu K, et al. Comparison of AO titanium locking plate and screw fixation versus anterograde intramedullary fixation for isolated unstable metacarpal and phalangeal fractures. Ortho Surg. 2016;8:316–322.

Download Key Publications PDF

Key Features

Comprehensive System
The system includes customizable Variable Angle Locking Plates, Small Bone External Fixator, Small Bone Distractor, and partially threaded lag screws.
Specialized Plates
Rolando Fracture Hook, Metacarpal Neck Fracture, Avulsion Hook, Curved Medial/Lateral and Rotational Correction plates.
Versatile Screw-and-Plate System
The system was the first in the industry to allow multiple Hand Fracture System screw diameters in every hole of every plate in the system.
Specialized Instruments
Specialized instruments in the system include an osteotomy cutting guide, the SaveLoc compression sleeve, unique clamps and forceps, and a plate cutter.

360° Rotation

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Hand Fracture Solutions That Have You Covered

From straightforward to specialized solutions, Acumed l OsteoMed offers a comprehensive portfolio of upper extremity fixation and specialty plates.

Explore Acumed | OsteoMed Hand Fracture Solutions

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Video Tour

This animated overview of the Hand Fracture System illustrates how the system is designed to surgically treat various metacarpal and phalangeal fractures, fusions, and osteotomies. Precontoured standard plates, specialty plates, Hexalobe MultiScrews, Hexalobe Lag Screws, and external fixation devices provide multiple surgical options for the hand.

The Hand Fracture System Plate Family

Acumed offers the all-in-one Hand Fracture System for management of fractures, fusions, and osteotomies for distal, middle, and proximal phalanges and metacarpals. This low-profile, multi-plate system features precontoured standard and specialty plates, Hexalobe MultiScrews, Hexalobe Lag Screws, pins, and external fixation devices, which are all included to streamline the surgical experience. Acumed’s Hexalobe MultiScrew technology allows for the same screw to act as a nonlocking and locking variable angle screw, eliminating the need for traditional locking and nonlocking screws. Innovative instrumentation is provided for provisional fixation, along with a rounded-edge plate cutter designed to minimize soft tissue irritation. This comprehensive system contains multiple surgical treatment options for the hand in one convenient tray.

The 0.8 mm Avulsion Hook Plate is designed to provide more stability than a K-wire when a fragment is too small for a single lag screw. The prongs in the 0.8 mm Avulsion Hook Plate are used to support an avulsion fragment when the avulsed fragment is too small for a lag screw and more stability is desired than pinning with K-wires alone can provide. This can often occur at the insertion of the collateral ligaments in the proximal phalanges.

The 1.3 mm Rolando Fracture Hook Plate is designed for a three-part fracture pattern at the base of the first metacarpal. The prongs on the proximal end of the 1.3 mm Rolando Fracture Hook Plate should contact the dorsal surface of the abductor pollicis longus (APL) tendon and support any comminution of the base of the first metacarpal. These prongs are not intended to compress the APL tendon down to the bone and a gap may be visible between the plate prongs and the bone on X-ray.

The 1.3 mm Metacarpal Neck Plate is designed to provide fixation for metacarpal neck fractures. The plate is positioned dorso-laterally. If a medial placement is preferred, the plate opposite to the hand may be used, i.e., the right metacarpal neck plate on the left hand.

The 1.3 mm Rotational Correction Plate is designed to be used with an osteotomy for correcting rotational malunions. A Rotational Osteotomy Cutting Guide is included in the Hand Fracture System that is designed to facilitate precise placement and orientation of cuts for rotational osteotomies of the metacarpals.

The 0.8 mm Offset Plate is designed to provide fixation for diaphyseal fractures. The 0.8 mm Curved Medial/Lateral Plate is designed for diaphyseal fractures when a medial or lateral approach is preferred. Offset Plates and Curved Medial/Lateral Plates, like all of the Hand Fracture System plates, are low profile, designed to reduce soft tissue irritation. All plates may be bent to fit and cut to length to better fit specific patient anatomy.

Standard plates include the Offset Plate, 6- and 10-Hole Straight Plates, and T-Plates. These plates come in 0.8 mm and 1.3 mm thicknesses, except the Offset Plate which is 0.8 mm only. Plates may be bent to fit and cut to length to better fit individual patient anatomy. Custom plate cutters included in the Hand Fracture System tray are designed to leave a rounded edge, designed to reduce soft tissue irritation. Plate cutters may be used with any Hand Fracture System plate except the Avulsion Plate.

Case Studies

ORIF of First Metacarpal Base Fracture: Marc J. Richard, MD: A 55-year-old, right-hand-dominant male fractured the base of his right first metacarpal during a fall at work. He was treated with a Rolando Fracture Hook Plate from the Acumed Hand Fracture System.

Phalangeal and Forearm Open Fractures Treatment With Internal and External Fixation: Marc J. Richard, MD: A 34-year-old gunshot wound victim with a highly comminuted forearm fracture and an index finger injury was treated with the Acumed Small Bone External Fixator and an anatomic forearm plate.

Metacarpal Lengthening Using Distraction Osteogenesis: Marc J. Richard, MD: Post-amputation of his thumb, a 38-year-old male opted for metacarpal lengthening with the Acumed Small Bone Distractor to create a thumb that could allow pinch and grasp.

Open Reduction and Internal Fixation of the Proximal Phalanx: Marc J. Richard, MD: A 62-year-old man sustained a proximal phalanx fracture in Iraq. After initial external fixation, he was treated with open reduction and internal fixation using a Curved Medial/Lateral Plate from the Acumed Hand Fracture System.

Open Reduction & Internal Fixation of a Fifth Metacarpal Neck Fracture: Marc J. Richard, MD: A 24-year-old woman sustained multiple fractures in a motor vehicle accident, including a metacarpal neck fracture. This fracture was reduced and fixed using a Metacarpal Neck Plate from the Hand Fracture System.

View Case Studies

Hexalobe MultiScrew and Lag Screw Technology

1. Designed to be used with any plate in the Hand Fracture System, 1.5 mm and 2.3 mm Hexalobe MultiScrews act as nonlocking screws when inserted into unthreaded slots and locking variable angle screws when inserted into threaded holes. The Hexalobe MultiScrew design allows for angles of up to 15 degrees in any direction for a total of 30 degrees. The SaveLock Compression Sleeve is designed to aid with plate reduction.

2. Designed to be used as an adjunct to plate fixation or for fractures which can be treated with lag screws alone, the 1.5 mm and 2.3 mm Hexalobe Lag Screws do not require overdrilling of the near cortex. Hexalobe Lag Screws are intended to be used independently of plates or through slotted plate holes only. When using lag screws as nonlocking screws in plates, ensure the screw engages the far cortex since lag screws are partially threaded and unable only partially to engage the near cortex. It is recommended to not use more than two lag screws per plate if they are being used as nonlocking screws.

Numerous Possible Plate Configurations

The Acumed Hand Fracture System offers plates in 0.8 mm and 1.3 mm thicknesses. Plates can be cut to length and bent to fit to better treat a wide variety of fracture patterns.

Multiple Choices, Multiple Options

Custom plate cutters are included in the Acumed Hand Fracture System, and are designed to create a smooth rounded edge on all plates except the Avulsion Plate. These plates feature divots that aid in provisional fixation when used with the system's forceps and clamps.