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Plating of Metacarpal Fractures: Unicortical or Bicortical Screws?

From the Orthopaedic Research Laboratory, Prince of Wales Hospital, University of New South Wales, Sydney, Australia and University of New South Wales, Plastic & Craniofacial Surgery Research Unit, Prince of Wales Hospital, Sydney, Australia

Correspondence: Dr. W.R. Walsh, Orthopaedic Research Laboratories, Prince of Wales Hospital, University of New South Wales, Randwick, 2031, Sydney, Australia. Tel.: +612-9382-2657; fax: +612- 9382-2660; E-mail: w.walsh{at}unsw.edu.au

Mid-shaft transverse osteotomies were performed in 18 cadaveric metacarpals and randomly divided into two groups. Using dorsally applied plates for repair, one group was secured using 6 mm unicortical screws, while bicortical screws were used in the second group. The metacarpals were tested to failure with a four-point bending protocol using a servo-hydraulic testing machine and a 1 kN load cell. The mean load to failure was 596 N (SD=142) for the unicortical and 541 N (SD=171) for the bicortical group. The stiffness was 333 N/mm (SD=116) for the unicortical and 458 N/mm (SD=158) for the bicortical group. Both load to failure and stiffness were not statistically significant between the two groups. Failure occurred by fracture at the screw-bone interface in all specimens: no screw pull-out was observed. No biomechanical advantage was found when using bicortical screws in metacarpal fracture plating.

Key Words: metacarpal • fracture • plating • bicortical • unicortical

Journal of Hand Surgery (British and European Volume), Vol. 29, No. 3, 216-219 (2004)
DOI: 10.1016/J.JHSB.2003.12.002


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