What are the key points of a proximal metaphyseal fracture?

From the Guidelines

Proximal metaphyseal fractures require prompt and accurate management to prevent significant morbidity and mortality, and to maintain quality of life, with surgical intervention being the preferred treatment option for most cases, as it provides stable fixation and allows for early mobilization. When managing proximal metaphyseal fractures, it is essential to consider the fracture pattern, displacement, and patient factors to determine the best course of treatment. Key management principles include:

• Accurate diagnosis through appropriate imaging (X-rays with possible CT scans for complex fractures)
• Proper alignment restoration
• Stable fixation using internal fixation with plates and screws or intramedullary nails, as seen in studies such as 1
• Special attention to the blood supply in metaphyseal regions to prevent avascular necrosis
• Early mobilization to prevent joint stiffness and muscle atrophy Treatment options vary, with non-displaced fractures potentially being managed conservatively with immobilization for 4-6 weeks, while displaced fractures often require surgical intervention, as noted in 1. Complications to monitor include malunion, delayed union, joint stiffness, and post-traumatic arthritis. The metaphyseal bone's cancellous structure provides good healing potential but may require bone grafting in comminuted fractures with bone loss, and regular follow-up with serial radiographs is essential to ensure proper healing and alignment maintenance. In cases of metastatic disease, prophylactic surgery is recommended for situations such as persistent or increasing local pain despite radiation therapy, a solitary well-defined lytic lesion circumferentially involving > 50% of the cortex, or involvement of the proximal femur associated with a fracture of the lesser trochanter, as outlined in 1. Overall, the goal of treatment is to achieve stable fixation, promote healing, and maintain quality of life, with surgical intervention being the preferred option for most cases, as supported by studies such as 1 and 1.

From the Research

Proximal Metaphyseal Fracture Key Points

• The management of proximal metaphyseal fractures can be challenging due to the complexity of the fracture and the surrounding soft tissue damage 2.
• Minimally invasive percutaneous plate osteosynthesis (MIPPO) is a technique that can be used to treat proximal metaphyseal fractures, and it has been shown to be effective in achieving satisfactory outcomes 2, 3.
• The use of a locking plate as an external fixator is a viable option for treating proximal metaphyseal fractures, and it has been shown to be safe and reliable with minimal complications 3.
• The choice of surgical approach and fixation method depends on the specific fracture pattern and the patient's individual needs 2, 4.
• Percutaneous Kirschner wire fixation is a simple and effective technique for treating fractures at the junction of the diaphysis and metaphysis of the proximal phalanges in adults 5.
• Pain management after operative treatment of an extremity fracture is an important aspect of care, and acetaminophen has been shown to be a effective and safe option for pain relief 6.

Treatment Options

• MIPPO technique using a 4.5 mm DCP, LC-DCP, or LISS plate 2
• External fixation using a femoral LISS plate 3
• Percutaneous Kirschner wire fixation 5
• Open reduction and internal fixation using a variety of plates and screws 4

Outcomes

• Satisfactory functional outcomes can be achieved with proper treatment 2, 3, 4, 5
• Complications such as nonunion, deep infection, and loosening of screws and plates can be minimized with proper technique and patient selection 2, 3
• Pain relief can be effectively managed with acetaminophen 6