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14:40 Metacarpal Fracture Fixation: Comparison of Novel Technique (Intramedullary Interlock Nailing) with Conventional Intramedullary K-Wiring Dr M K Agrawal, Mr K J Patel, Mr S P Hodgson (Bolton) Introduction: Indications and methods of surgical treatment of displaced metacarpal fractures are varied. Intramedullary interlocking nailing (Hand Innovations) for metacarpal fractures is a relatively new technique, which is indicated for rotationally unstable fractures. However, there is little evidence to compare the results of intramedullary nailing with conventional intramedullary K-wiring. Materials and Methods: A retrospective study with review of case notes and radiographs was conducted for seventeen patients undergoing K-wiring and 15 patients undergoing intramedullary interlocked nailing between February 2007 and August 2007. All patients were followed up for at least three months. Results: Both groups had patients with comparable demographic features, fracture patterns and mechanism of injury. The mean time for fracture union, both clinically and radiologically was 5.4 weeks for the K- wiring group and 6.2 weeks for the intramedullary locking nail group (p>0.05). Time of return to work was comparable in both groups. No rotational mal-alignment was noted in any patient at final follow-up. All patients underwent removal of metalwork following fracture healing. All patients undergoing IM nailing had general anaesthetic for implant removal, as compared to four undergoing K-wiring. The complication rate was higher in the IM nailing group (4/15: stiffness, infection versus 3/17 for K-wiring group: infection, extensor tendon injury). Conclusions: Intramedullary nailing is theoretically better for rotationally unstable metacarpal fractures, but our study shows no definite advantage over K-wiring. Also, the nail removal exposed the patients to additional risk of general anaesthetic, and increased cost of management, including cost of implant and removal. 14:45 Inter-Observer Variation in the Radiographic Measurement of Fifth Metacarpal Neck Fractures Miss Z Goldthorpe, Mr S J Lee, Mr S M Wilson (Bristol) 14:50 Discussion THURSDAY, 1 MAY Introduction: Fifth metacarpal neck fractures make up a significant proportion of hand trauma seen and treated by emergency departments and hand surgical units. Outpatient follow-up rates are less than satisfactory and treatment preference varies greatly between units. The degree of angulation determines necessity of surgical intervention, together with clinical examination. Our aim was to measure the interobserver variation when assessing radiographs across specialities and grades to assess if further protocols regarding treatment can be instigated after initial assessment. Methods: Five radiograph series (anteroposterior, oblique and lateral in four of the five fractures) of patients with ‘boxers’ fractures were reviewed independently by three consultants and three higher training grade doctors in emergency medicine, plastic surgery, orthopaedic surgery and radiology. Degree of angulation was tabulated for analysis. Results: Scatter diagrams were created to visually assess the variance between the twenty-four subjects of all studied specialities and grades. Variability occurred between grades of the same speciality and most obviously between specialities. Inter-observer variance was found to be non predictable between specialities. Clinical Relevance: This work suggests that radiographic assessment by a single clinician may lead to over treatment through referral for surgery, and the importance of clinical examination is to be reiterated. Decisions regarding initial treatment, surgery and follow-up require specialist input. 6
THURSDAY, 1 MAY 14:57 A Modified Approach of the Reverse Dorsal Metacarpal Island Flap: Anatomical Basis and Application in Twenty-four Cases Professor L J Lu, Professor G Xu (Chang Chun) Introduction: The authors introduce a modified approach of the reverse dorsal metacarpal island flap (DMIF). Material: We observed and measured the parameters of the distal cutaneous branches arising from the 2-4 DMCAs in thirty-four specimens, and designed a new approach of the reverse DMIF. The axis of the flap is the midline between two adjacent metacarpals, from the leading edge of the web space to the metacarpal bases. Two points of pivot can be chosen, i.e. 2.5° or 1.5° proximal to the leading edge of the web space. The 2.5° point of pivot is the originating site of the cutaneous branch distal to the juncturae tendinum. The 2.5° point of pivot is chosen to cover the dorsum of the proximal phalanx. The 1.5° point of pivot is the site of anastomosis between DMCA and the common or proper palmar digital artery. The 1.5° point of pivot is used to cover volar or dorsal skin defect proximal to the DIP joint. The plane of dissection is along the extensor paratenon. From 2003 to 2006, we applied this approach in twenty-four patients. Results: The 2nd and 3rd DMCAs constantly gave off this cutaneous branch, but there was no cutaneous branch arising from the 4th DMCA in four among 34 specimens. All flaps survived completely except two cases of venous congestion, which were relieved through bleeding. Conclusions: Based on the distal cutaneous branches arising from the 2-4 DMCA, the elevation of the reverse DMIF can be simplified. 15:07 Resveratrol and Tendon Healing: More Reasons to Drink Red Wine Mr B Klass, Dr K J Rolfe, Mr A O Grobbelaar (Northwood) Introduction: Flexor tendon adhesions remain a problem following primary tenorrhaphy. Resveratrol is a natural extract from red wine and grapes and has already been shown to reduce peritoneal adhesions in a rat model. Our aim was to determine if Resveratrol had the potential to reduce adhesion formation and optimise healing in flexor tendons using an in vitro model. Materials and Methods: Rabbit flexor tendons were dissected and cultured separately as epitenon, endotenon and sheath cells. Cells were treated with 50µM Resveratrol over a time course. Real time PCR was performed on a number of genes associated with either wound healing [collagen type I and type III], or adhesion formation [fibronectin, plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA)]. Statistical analysis was performed using the relative expression software tool (REST © ). Results: Epitenon cells showed a significant increase in collagen type I gene transcription at four and 24 hours (p
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