A Novel Tie to Assist Metacarpal Fracture Reduction and Fixation

A Novel Tie to Assist Metacarpal Fracture Reduction and Fixation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Novel Tie to Assist Metacarpal Fracture Reduction and Fixation Xiaolong Wang, Chao Yin, Tao Sun, Dong Jiang, Guorong Zhang, Zhiqiang Shi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7495458/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study is to evaluate the clinical value of a novel tie assisted open reduction and internal fixation for the treatment of metacarpal fractures. Methods A total of 8 cases of metacarpal fractures were treated with novel tie assisted open reduction plate and screw internal fixation. We evaluated the results based on the complications, fracture healing time, return to work time, grip strength, range of motion of the metacarpophalangeal joint (MCP), disability of the arm, shoulder, and hand (DASH) score, visual analogue scale (VAS) score, and patient satisfaction. Results The mean operative time was 38.5 minutes, the mean intraoperative blood loss was 23.13 mL, the mean times of fluoroscopies was 3.5, and all patients achieved anatomic reduction or near-anatomic reduction. The mean follow-up time was 7.5 months. All patients achieved fracture healing and the mean bone union time was 7.5 weeks. The mean DASH score was 2.29, the mean VAS score was 0.5, the mean ROM of the MCP was 96.75% and the mean grip strength was 97.88% of the healthy finger, and the mean time to return to work was 8.5 ± 2.07 weeks. According to the Short Assessment of Patient Satisfaction, 7 cases were very satisfied and 1 case was satisfied. There were no complications such as infection, tendon injury, loosening, slipping, breaking or even loss of fracture reduction related to the the tie. Conclusions The novel tie is a convenient, efficient and safe means of assisted reduction and fixation of metacarpal fractures. Clinical trial number: not applicable. Metacarpal Fracture Reduction Fixation Tie Plate Figures Figure 1 Figure 2 Introduction Metacarpal fractures can usually be classified as transverse, oblique, spiral, or comminuted. Most metacarpal fractures are usually treated nonoperatively with plaster casts and splints [ 1 – 2 ] , but these methods do not allow for early functional exercise and are not very stable, causing joint stiffness and loss of range of motion. Open or closed reduction and fixation is recommended for unstable or comminuted metacarpal fractures, such as oblique or spiral fractures, because surgery can achieve better force alignment, anatomic reduction, and functional results [ 3 – 4 ] . The methods of fixation of fractures include Kirschner wires (K-wires), external fixation braces, intramedullary nails, tension band wires, plates and screws or screw fixation alone, and bioabsorbable plates [ 3 – 8 ] ], of which K-wires, plates and screws are the most commonly used fixation methods. However, K-wires fixation devices are associated with complications such as finger stiffness, K-wires tract infection, and fracture redisplacement due to loosening of K-wires [ 5 – 6 , 9 – 10 ] . Although open reduction and plate internal fixation have disadvantages such as extensor tendon adhesion and irritation, wound infection, and possible removal of internal implants in the later stage [ 1 , 8 , 11 – 13 ] , it can achieve anatomical reduction and strong internal fixation, facilitating early active rehabilitation activities for patients, thereby achieving excellent functional results and reducing complications [ 10 , 12 – 14 ] , and it is the preferred treatment for metacarpal fractures by many physicians. The methods of reduction and fixation are particularly important for the treatment of metacarpal fractures. Traditional means of fracture reduction and fixation, such as bone-holder clamping, K-wires fixation, and wire tie reduction, although meeting the clinical needs to a certain extent, their complexity of operation, instability of the reduction effect, obstruction of fluoroscopy affecting fluoroscopy judgment, and potential soft-tissue injuries limit their wide application in clinical practice. Especially for spiral and oblique metacarpal fractures, if the reduction is not good, it may lead to later dysfunction, such as finger deformity, joint stiffness, tendon adhesion, etc.. Therefore, to find a more accurate, convenient and safe method of intraoperative reduction and fixation has been the focus of orthopaedic surgeons. In this context, this study introduced a novel tie to solve the limitations of traditional reduction and fixation techniques and provide a more convenient and efficient means of fracture reduction and fixation. We expect that the application of this novel tie can effectively improve the surgical effects. Methods From January 2024 to July 2025, 8 adult patients with metacarpal fractures who received surgical treatment in our hospital were enrolled. The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University (approval number: EFY20240043), and all patients' informed consent was signed. This study was performed under the ethical standards of the 1964 Declaration of Helsinki. The inclusion criteria [ 15 ] included: (1) adult patients aged 18–60 years; (2) closed fractures without tendon, nerve, or vascular injury; and (3) fractures angulated ≥ 30, rotated ≥ 5°, and/or shortened ≥ 5 mm. The exclusion criteria [ 15 ] included: (1) patients 65 years of age; (2) patients with tendon, nerve, or vascular injury polytrauma, fracture dislocation, open fractures, old fractures, and pathologic fractures; and (3) exclusion of those patients with severe osteoporosis, infectious condition, rheumatoid arthritis, gout, malignant neoplasms, diabetes mellitus, immunodeficiency diseases, and musculoskeletal disorders affecting the rehabilitation of the hand. All surgeries are performed by a a permanent team of experienced orthopedic surgeons. Surgical technique The operation was performed under brachial plexus anesthesia with a tourniquet in the upper arm. The dorsal approach was used to cut the skin and subcutaneous tissue, retract the extensor tendon, strip the periosteum, and expose the broken end of the fracture. Debridement of hematoma and embedded soft tissue at the fracture end. For metacarpal head and neck fracture, the extensor tendons are split and repaired after the fracture was reduced and fixed. The fracture was reduced under direct vision, and a novel tie was used to pass through the fracture end, mini-metacarpal anatomical titanium plates were plated and then longitudinally retracted in combination with a novel tie reduction. We adjusted the tie to resist shear and rotational forces at the bone ends and to ensure stability at the fracture ends. Throughout the operation, we closely monitored the effectiveness of the novel tie to prevent fracture displacement due to loosening or slippage. We confirmed the accuracy of the fracture reduction and the effect of the novel tie by small C-arm X-ray fluoroscopy, and screw fixation was performed after confirming good position reduction, a final C-arm fluoroscopy confirmed fracture reduction and fixation was reliable, we rinsed and closed the wound and wrapped the wound with a sterile dressing(See Fig. 1 – 2 ). Postoperative management and evaluation: intravenous infusion of mannitol and elevation of the limb swelling, oral antibiotics for 3–5 days. Patients were encouraged to exercise as early as possible. After the anesthesia subsided, the patients were instructed to perform active exercises. We recorded the patient's age, gender, injury mechanism, fracture type, fracture site and other basic information before operation. During hospitalization, we recorded the operation time, intraoperative blood loss, fluoroscopy times, length of hospital stay and other indicators, the subjective evaluation of the fracture reduction accuracy by the surgeon and the intraoperative X-ray fluoroscopy were used to evaluate the success rate of reduction. During the follow-up period, we collected patient complications (such as infection, tendon injury, superficial nerve injury, functional impairment, shortening or rotational deformity, secondary displacement, and fracture nonunion, etc.), fracture healing time, indicators of functional recovery, and time to return to work. Fracture healing was determined by absence of tenderness at the fracture site and review of X-ray, functional recovery measures mainly included metacarpophalangeal (MCP) range of motion (ROM), grip strength, visual analogue scale (VAS) scores for pain, and disability of the arm, shoulder, and hand (DASH) scores (0-100 points) [ 16 ] . Rom of active flexion and extension of the MCP joint was measured by a handheld goniometer [ 17 ] . Grip strength value was expressed as a percentage of the contralateral hand. Patient satisfaction was assessed using a short assessment of patient satisfaction (SAPS; 0–10, very dissatisfied; 11–18, dissatisfied; 19–26, satisfied; 27–28, very satisfied) [ 18 ] . In terms of safety assessment, we evaluated whether the novel tie was loose, slipping, or broken, as well as any adverse events such as discomfort or allergic reactions. At the same time, we closely monitored the impact on surrounding soft tissues, such as infection, neurovascular injury, and subcutaneous hematoma, to comprehensively evaluate the safety of the novel tie surgery. Results 8 patients with a mean age of 39.38 years (range 19–58 years) were included in this study. The mean duration from injury to surgery was 3.25 days (range, 1–7 days). The patients’ demographic characteristics are listed in Table 1 , such as age, gender, hand dominance on the injured side, injury mechanism, fracture type, fracture site and fractured metacarpal digits. In this study, the mean operative time was 38.5 minutes (range 28–60 minutes), the mean intraoperative blood loss was 23.13 mL (range 12–48 mL), the mean fluoroscopy of intraoperative fluoroscopies was 3.5 (range 2–6), and the mean length of hospital stay was 3.43 days (range 3–17 days). None of the patients had an interruption of the technique due to difficulty, and all patients achieved anatomic reduction or near-anatomic reduction. The mean follow-up time was 7.5 months (range 3 to 12 months). At the end of the follow-up period, all patients achieved fracture healing and the mean bone union time was 7.5 weeks (range, 6–10 weeks), there were no complications such as infection, tendon injury, superficial nerve injury, dysfunction, shortening or rotation deformity, secondary displacement and fracture nonunion. The mean DASH score was 2.29 (range 0 to 9.17), the mean VAS score was 0.5 (range 0 to 2), and the mean ROM of the MCP was 96.75% (range, 90–100%) of the healthy contralateral finger, the mean grip strength was 97.88% (range, 94–100%) of the contralateral finger, and the mean time to return to work was 8.5 ± 2.07 weeks. According to the Short Assessment of Patient Satisfaction, 7 cases (87.5%) were very satisfied and 1 case (12.5%) was satisfied, we got good results. The evaluation of the safety of the use of the tie showed that no loosening, slipping, breaking or even loss of fracture reduction, as well as adverse events such as discomfort or allergic reactions were found during the operation, and no infections, neurovascular injuries and subcutaneous hematomas related to the use of the tie were found after the operation, indicating that the tie performed well in terms of surgical safety. Discussion Locking plates and screws had shown promising results in the treatment of metacarpal fractures [ 10 , 13 , 19 ] . However, for spiral, oblique and comminuted fracture metacarpals, how to achieve a better reduction effect had been a puzzle for many orthopaedic surgeons. Here, our study provided a convenient, efficient and safe mean for the reduction and fixation of metacarpal fractures with a novel tie-assisted plate and screw. Novel tie had significant advantages in reducing the difficulty of surgical operation, maintaining the effect of reduction, and reducing the exposure to radiation, high reduction success rate, metacarpal fracture healed normally as expected, good grip strength, joint mobility and hand function, and no increase the length of hospital stay, high postoperative satisfaction of the patients, and no significant impact on the patients' return to normal work. At the same time, we did not find any loosening and slipping phenomena related to the use of the novel tie, or even serious neurovascular injury or infection events in the process of using the novel tie. The above results indicated the safety and effectiveness of the novel tie. The novel tie had demonstrated good adaptability and clinical application in the treatment of spiral, oblique and comminuted metacarpal fractures, could provide sufficient tension to maintain the reduction state, and could also resist shear and rotational forces to ensure the stability of the fracture. The fixation position and strength of the tie were adjusted to the characteristics of the fracture site, which reduced the interference with the surrounding soft tissues, reduced the risk of fracture displacement, and provided a more accurate reduction effect. In this study, we found that the novel tie can significantly reduce the number of fluoroscopies, reduce the difficulty of intraoperative fracture reduction, and does not increase the operation time and intraoperative blood loss, suggesting the superiority of the novel tie in reducing the complexity of surgery and radiation exposure. In particular, for the common problem of intraoperative fluoroscopy problems in orthopedic surgery, the application of the novel tie significantly reduced this indicator and lowered the radiation exposure of doctors and patient. This finding is particularly important for complex fracture surgeries that require multiple fluoroscopies, as it not only reduces radiation risk, but also contributes to surgical efficiency. Compared with the traditional metal wire ring cerclage reduction and fixation method, the novel tie reduced the steps of cutting, bending and threading of wire ring during surgery, simplified the operation process, did not disrupt the blood supply of the fracture end, and did not affect the healing of the fracture, and intraoperative fluoroscopy was not yet visible, and did not require a second operation to remove the internal fixation [ 20 – 21 ] . In the same principle as Nice Knot cerclage [ 22 ] , the fracture was reducted and fixed by tightening novel tie across the circumference of the metacarpal bone and did not irritate tendons and other tissues. Unlike hemicerclage [ 23 ] and bone tie [ 5 , 21 , 24 ] , we did not need to drill holes in the metacarpal bone, and the performation was very simple, but was stronger than the sutures of Nice Knot cerclage, and did not suffer from cuts and breaks, as was the case with the use of stainless steel wires (SS wires) [ 5 , 21 ] and the Nice Knot for assisted fracture reduction. Despite the overall good results of reduction and fixation with the tie, we had conducted preliminary explorations in clavicle fractures and achieved better results. However, it was worth noting that the use of the novel tie may be limited for some complex types of fractures such as intra-articular fractures. Due to the occlusion of soft tissues such as the joint capsule and lateral collateral ligaments around the joint, it was difficult to fix the tie tightly, and if the fixation was too tight it may have some effect on the soft tissues around the joint, and it may need to be completed by combining with other reduction tools or techniques. In addition, this study was a single-center study, not a randomized controlled study, with a small clinical sample size and a short follow-up time, which inevitably had bias. Therefore, larger clinical studies and further optimization were still needed to ensure their widespread application. Conclusion The novel tie has demonstrated its potential as a convenient, efficient and safe means of reduction and fixation in the clinical application of metacarpal fractures, with significant advantages in terms of reducing surgical complexity, reducing radiation risk, improving reduction effect and improving surgical efficiency, and high patient satisfaction. Abbreviations DASH Disabilities of the Arm, Shoulder and Hand VAS Visual analog scale ROM Range of motion TAM Total active motion MCP Metacarpophalangeal SAPS Short Assessment of Patient Satisfaction. Declarations Acknowledgments We would like to express gratitude to all the patients and their families. Author ' C ontributions Shangfei Jing, Zhiqiang Shi and Jihong Wang had the major role in creating the plan, reviewing and editing manuscript. Shangfei Jing, and Xiaolong Wang had the major role in obtaining grants. Xiaolong Wang wrote the original manuscript. Chao Yin, Tao Sun, Dong Jiang, Guorong Zhang, Zhiqiang Shi collected the clinical data. All authors have reviewed and approved the final manuscript. Funding This study was supported by the Science and Technology Project for Building High-level Clinical Specialties in Public Hospitals in the Capital Region of Health Committee of Inner Mongolia Autonomous Region (No. 2024SGGZ118 and No. 2023SGGZ144) Availability of data and materials All data generated or analyzed during this study are included in this article. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. Ethics approval and consent to participate Ethical approval was obtained from the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University (approval number: EFY20240043) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki, all patients provided written informed consent for participation and the use of their data in the study. Consent for publication Not applicable. Competing interests The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Contributor information*: Shangfei Jing, E-mail: [email protected] . Jihong Wang, E-mail: 2503455372 @qq.com . References Hiatt SV, Begonia MT, Thiagarajan G, et al. Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures[J]. J Hand Surg Am, 2015, 40(8):1586-1590. DOI: 10.1016/j.jhsa.2015.03.035. Galbraith JG, Huntington LS, Borbas P, et al. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures[J]. J Hand Surg Eur Vol, 2022, 47(2):172-178. DOI: 10.1177/17531934211017705. Cheah AE, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations[J]. J Hand Surg Am, 2016, 41(6):712-722. DOI: 10.1016/j.jhsa.2016.03.007. Allen ST, Wang OJ, Erickson LO, et al. 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02:43:00","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75230,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7495458/v1/9fc5796fa9ef27d890db9b85.html"},{"id":91932382,"identity":"3c52a4fd-f212-4b99-a2a6-e71d15404be5","added_by":"auto","created_at":"2025-09-23 02:35:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154995,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of using tie to assist in the reduction and fixation of metacarpal fractures with steel plates and screws (a-h).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7495458/v1/4ce6d3a4b52f78cfc3bdcc92.png"},{"id":91932391,"identity":"3ca75470-6f08-4db9-a185-a08e705b0ec6","added_by":"auto","created_at":"2025-09-23 02:35:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":224785,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative case: Schematic diagram showing intraoperative use of novel tie assisted reduction and fixation of the 4th metacarpal fracture with plate and screws. (a) The preoperative X-ray of the hand oblique views showing a spiral fracture of the 4th metacarpal. (b-c) Schematic diagram of fixation of metacarpal fracture with a novel tie. (d-e)The intraoperative X-ray showed good reduction of the 4th metacarpal fracture, and the novel tie did not show up under X-ray fluoroscopy, which did not interfere with the judgment of fracture reduction. (f) Good reduction of the fracture and removal of the novel tie\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7495458/v1/014ad6a2e8bd69cc729f2f46.png"},{"id":92404327,"identity":"ffef39cb-5395-4680-b016-404a183c3638","added_by":"auto","created_at":"2025-09-29 10:53:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":915207,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7495458/v1/94247bc9-3c6b-458e-a2ca-8b4a01acd13c.pdf"},{"id":91932384,"identity":"aa278607-c631-46a4-8e40-5c17835f21ec","added_by":"auto","created_at":"2025-09-23 02:35:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16482,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7495458/v1/dc728bcd15ad748b051ee684.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Novel Tie to Assist Metacarpal Fracture Reduction and Fixation\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMetacarpal fractures can usually be classified as transverse, oblique, spiral, or comminuted. Most metacarpal fractures are usually treated nonoperatively with plaster casts and splints\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, but these methods do not allow for early functional exercise and are not very stable, causing joint stiffness and loss of range of motion. Open or closed reduction and fixation is recommended for unstable or comminuted metacarpal fractures, such as oblique or spiral fractures, because surgery can achieve better force alignment, anatomic reduction, and functional results\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eThe methods of fixation of fractures include Kirschner wires (K-wires), external fixation braces, intramedullary nails, tension band wires, plates and screws or screw fixation alone, and bioabsorbable plates\u003csup\u003e[\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e], of which K-wires, plates and screws are the most commonly used fixation methods. However, K-wires fixation devices are associated with complications such as finger stiffness, K-wires tract infection, and fracture redisplacement due to loosening of K-wires\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Although open reduction and plate internal fixation have disadvantages such as extensor tendon adhesion and irritation, wound infection, and possible removal of internal implants in the later stage\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, it can achieve anatomical reduction and strong internal fixation, facilitating early active rehabilitation activities for patients, thereby achieving excellent functional results and reducing complications \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, and it is the preferred treatment for metacarpal fractures by many physicians.\u003c/p\u003e\u003cp\u003eThe methods of reduction and fixation are particularly important for the treatment of metacarpal fractures. Traditional means of fracture reduction and fixation, such as bone-holder clamping, K-wires fixation, and wire tie reduction, although meeting the clinical needs to a certain extent, their complexity of operation, instability of the reduction effect, obstruction of fluoroscopy affecting fluoroscopy judgment, and potential soft-tissue injuries limit their wide application in clinical practice. Especially for spiral and oblique metacarpal fractures, if the reduction is not good, it may lead to later dysfunction, such as finger deformity, joint stiffness, tendon adhesion, etc.. Therefore, to find a more accurate, convenient and safe method of intraoperative reduction and fixation has been the focus of orthopaedic surgeons. In this context, this study introduced a novel tie to solve the limitations of traditional reduction and fixation techniques and provide a more convenient and efficient means of fracture reduction and fixation. We expect that the application of this novel tie can effectively improve the surgical effects.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFrom January 2024 to July 2025, 8 adult patients with metacarpal fractures who received surgical treatment in our hospital were enrolled. The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University (approval number: EFY20240043), and all patients' informed consent was signed. This study was performed under the ethical standards of the 1964 Declaration of Helsinki. The inclusion criteria\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e included: (1) adult patients aged 18\u0026ndash;60 years; (2) closed fractures without tendon, nerve, or vascular injury; and (3) fractures angulated\u0026thinsp;\u0026ge;\u0026thinsp;30, rotated\u0026thinsp;\u0026ge;\u0026thinsp;5\u0026deg;, and/or shortened\u0026thinsp;\u0026ge;\u0026thinsp;5 mm. The exclusion criteria\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e included: (1) patients\u0026thinsp;\u0026lt;\u0026thinsp;18 years of age and age\u0026thinsp;\u0026gt;\u0026thinsp;65 years of age; (2) patients with tendon, nerve, or vascular injury polytrauma, fracture dislocation, open fractures, old fractures, and pathologic fractures; and (3) exclusion of those patients with severe osteoporosis, infectious condition, rheumatoid arthritis, gout, malignant neoplasms, diabetes mellitus, immunodeficiency diseases, and musculoskeletal disorders affecting the rehabilitation of the hand. All surgeries are performed by a a permanent team of experienced orthopedic surgeons.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSurgical technique\u003c/h2\u003e\u003cp\u003eThe operation was performed under brachial plexus anesthesia with a tourniquet in the upper arm. The dorsal approach was used to cut the skin and subcutaneous tissue, retract the extensor tendon, strip the periosteum, and expose the broken end of the fracture. Debridement of hematoma and embedded soft tissue at the fracture end. For metacarpal head and neck fracture, the extensor tendons are split and repaired after the fracture was reduced and fixed. The fracture was reduced under direct vision, and a novel tie was used to pass through the fracture end, mini-metacarpal anatomical titanium plates were plated and then longitudinally retracted in combination with a novel tie reduction. We adjusted the tie to resist shear and rotational forces at the bone ends and to ensure stability at the fracture ends. Throughout the operation, we closely monitored the effectiveness of the novel tie to prevent fracture displacement due to loosening or slippage. We confirmed the accuracy of the fracture reduction and the effect of the novel tie by small C-arm X-ray fluoroscopy, and screw fixation was performed after confirming good position reduction, a final C-arm fluoroscopy confirmed fracture reduction and fixation was reliable, we rinsed and closed the wound and wrapped the wound with a sterile dressing(See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cp\u003ePostoperative management and evaluation: intravenous infusion of mannitol and elevation of the limb swelling, oral antibiotics for 3\u0026ndash;5 days. Patients were encouraged to exercise as early as possible. After the anesthesia subsided, the patients were instructed to perform active exercises.\u003c/p\u003e\u003cp\u003eWe recorded the patient's age, gender, injury mechanism, fracture type, fracture site and other basic information before operation.\u003c/p\u003e\u003cp\u003eDuring hospitalization, we recorded the operation time, intraoperative blood loss, fluoroscopy times, length of hospital stay and other indicators, the subjective evaluation of the fracture reduction accuracy by the surgeon and the intraoperative X-ray fluoroscopy were used to evaluate the success rate of reduction.\u003c/p\u003e\u003cp\u003eDuring the follow-up period, we collected patient complications (such as infection, tendon injury, superficial nerve injury, functional impairment, shortening or rotational deformity, secondary displacement, and fracture nonunion, etc.), fracture healing time, indicators of functional recovery, and time to return to work. Fracture healing was determined by absence of tenderness at the fracture site and review of X-ray, functional recovery measures mainly included metacarpophalangeal (MCP) range of motion (ROM), grip strength, visual analogue scale (VAS) scores for pain, and disability of the arm, shoulder, and hand (DASH) scores (0-100 points)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Rom of active flexion and extension of the MCP joint was measured by a handheld goniometer\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Grip strength value was expressed as a percentage of the contralateral hand. Patient satisfaction was assessed using a short assessment of patient satisfaction (SAPS; 0\u0026ndash;10, very dissatisfied; 11\u0026ndash;18, dissatisfied; 19\u0026ndash;26, satisfied; 27\u0026ndash;28, very satisfied)\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eIn terms of safety assessment, we evaluated whether the novel tie was loose, slipping, or broken, as well as any adverse events such as discomfort or allergic reactions. At the same time, we closely monitored the impact on surrounding soft tissues, such as infection, neurovascular injury, and subcutaneous hematoma, to comprehensively evaluate the safety of the novel tie surgery.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e8 patients with a mean age of 39.38 years (range 19\u0026ndash;58 years) were included in this study. The mean duration from injury to surgery was 3.25 days (range, 1\u0026ndash;7 days). The patients\u0026rsquo; demographic characteristics are listed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, such as age, gender, hand dominance on the injured side, injury mechanism, fracture type, fracture site and fractured metacarpal digits.\u003c/p\u003e\n\u003cp\u003eIn this study, the mean operative time was 38.5 minutes (range 28\u0026ndash;60 minutes), the mean intraoperative blood loss was 23.13 mL (range 12\u0026ndash;48 mL), the mean fluoroscopy of intraoperative fluoroscopies was 3.5 (range 2\u0026ndash;6), and the mean length of hospital stay was 3.43 days (range 3\u0026ndash;17 days). None of the patients had an interruption of the technique due to difficulty, and all patients achieved anatomic reduction or near-anatomic reduction.\u003c/p\u003e\n\u003cp\u003eThe mean follow-up time was 7.5 months (range 3 to 12 months). At the end of the follow-up period, all patients achieved fracture healing and the mean bone union time was 7.5 weeks (range, 6\u0026ndash;10 weeks), there were no complications such as infection, tendon injury, superficial nerve injury, dysfunction, shortening or rotation deformity, secondary displacement and fracture nonunion.\u003c/p\u003e\n\u003cp\u003eThe mean DASH score was 2.29 (range 0 to 9.17), the mean VAS score was 0.5 (range 0 to 2), and the mean ROM of the MCP was 96.75% (range, 90\u0026ndash;100%) of the healthy contralateral finger, the mean grip strength was 97.88% (range, 94\u0026ndash;100%) of the contralateral finger, and the mean time to return to work was 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07 weeks. According to the Short Assessment of Patient Satisfaction, 7 cases (87.5%) were very satisfied and 1 case (12.5%) was satisfied, we got good results.\u003c/p\u003e\n\u003cp\u003eThe evaluation of the safety of the use of the tie showed that no loosening, slipping, breaking or even loss of fracture reduction, as well as adverse events such as discomfort or allergic reactions were found during the operation, and no infections, neurovascular injuries and subcutaneous hematomas related to the use of the tie were found after the operation, indicating that the tie performed well in terms of surgical safety.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLocking plates and screws had shown promising results in the treatment of metacarpal fractures\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. However, for spiral, oblique and comminuted fracture metacarpals, how to achieve a better reduction effect had been a puzzle for many orthopaedic surgeons. Here, our study provided a convenient, efficient and safe mean for the reduction and fixation of metacarpal fractures with a novel tie-assisted plate and screw. Novel tie had significant advantages in reducing the difficulty of surgical operation, maintaining the effect of reduction, and reducing the exposure to radiation, high reduction success rate, metacarpal fracture healed normally as expected, good grip strength, joint mobility and hand function, and no increase the length of hospital stay, high postoperative satisfaction of the patients, and no significant impact on the patients' return to normal work. At the same time, we did not find any loosening and slipping phenomena related to the use of the novel tie, or even serious neurovascular injury or infection events in the process of using the novel tie. The above results indicated the safety and effectiveness of the novel tie.\u003c/p\u003e\u003cp\u003eThe novel tie had demonstrated good adaptability and clinical application in the treatment of spiral, oblique and comminuted metacarpal fractures, could provide sufficient tension to maintain the reduction state, and could also resist shear and rotational forces to ensure the stability of the fracture. The fixation position and strength of the tie were adjusted to the characteristics of the fracture site, which reduced the interference with the surrounding soft tissues, reduced the risk of fracture displacement, and provided a more accurate reduction effect.\u003c/p\u003e\u003cp\u003eIn this study, we found that the novel tie can significantly reduce the number of fluoroscopies, reduce the difficulty of intraoperative fracture reduction, and does not increase the operation time and intraoperative blood loss, suggesting the superiority of the novel tie in reducing the complexity of surgery and radiation exposure. In particular, for the common problem of intraoperative fluoroscopy problems in orthopedic surgery, the application of the novel tie significantly reduced this indicator and lowered the radiation exposure of doctors and patient. This finding is particularly important for complex fracture surgeries that require multiple fluoroscopies, as it not only reduces radiation risk, but also contributes to surgical efficiency.\u003c/p\u003e\u003cp\u003eCompared with the traditional metal wire ring cerclage reduction and fixation method, the novel tie reduced the steps of cutting, bending and threading of wire ring during surgery, simplified the operation process, did not disrupt the blood supply of the fracture end, and did not affect the healing of the fracture, and intraoperative fluoroscopy was not yet visible, and did not require a second operation to remove the internal fixation\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. In the same principle as Nice Knot cerclage\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, the fracture was reducted and fixed by tightening novel tie across the circumference of the metacarpal bone and did not irritate tendons and other tissues. Unlike hemicerclage\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e and bone tie\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, we did not need to drill holes in the metacarpal bone, and the performation was very simple, but was stronger than the sutures of Nice Knot cerclage, and did not suffer from cuts and breaks, as was the case with the use of stainless steel wires (SS wires)\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e and the Nice Knot for assisted fracture reduction.\u003c/p\u003e\u003cp\u003eDespite the overall good results of reduction and fixation with the tie, we had conducted preliminary explorations in clavicle fractures and achieved better results. However, it was worth noting that the use of the novel tie may be limited for some complex types of fractures such as intra-articular fractures. Due to the occlusion of soft tissues such as the joint capsule and lateral collateral ligaments around the joint, it was difficult to fix the tie tightly, and if the fixation was too tight it may have some effect on the soft tissues around the joint, and it may need to be completed by combining with other reduction tools or techniques. In addition, this study was a single-center study, not a randomized controlled study, with a small clinical sample size and a short follow-up time, which inevitably had bias. Therefore, larger clinical studies and further optimization were still needed to ensure their widespread application.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe novel tie has demonstrated its potential as a convenient, efficient and safe means of reduction and fixation in the clinical application of metacarpal fractures, with significant advantages in terms of reducing surgical complexity, reducing radiation risk, improving reduction effect and improving surgical efficiency, and high patient satisfaction.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDASH\u003c/p\u003e\n\u003cp\u003eDisabilities of the Arm, Shoulder and Hand\u003c/p\u003e\n\u003cp\u003eVAS\u003c/p\u003e\n\u003cp\u003eVisual analog scale\u003c/p\u003e\n\u003cp\u003eROM\u003c/p\u003e\n\u003cp\u003eRange of motion\u003c/p\u003e\n\u003cp\u003eTAM\u003c/p\u003e\n\u003cp\u003eTotal active motion\u003c/p\u003e\n\u003cp\u003eMCP\u003c/p\u003e\n\u003cp\u003eMetacarpophalangeal\u003c/p\u003e\n\u003cp\u003eSAPS\u003c/p\u003e\n\u003cp\u003eShort Assessment of Patient Satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express gratitude to all the patients and their families.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003cstrong\u003e\u0026apos; C\u003c/strong\u003e\u003cstrong\u003eontributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShangfei Jing, Zhiqiang Shi and Jihong Wang had the major role in creating the plan, reviewing and editing manuscript. Shangfei Jing, and Xiaolong Wang had the major role in obtaining grants. Xiaolong Wang wrote the original manuscript. Chao Yin, Tao Sun, Dong Jiang, Guorong Zhang, Zhiqiang Shi collected the clinical data. All authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Science and Technology Project for Building High-level Clinical Specialties in Public Hospitals in the Capital Region of Health Committee of Inner Mongolia Autonomous Region (No. 2024SGGZ118 and No. 2023SGGZ144)\u003c/p\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003ch3\u003eAll data generated or analyzed during this study are included in this article.\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Committee of the Second Affiliated Hospital of Inner Mongolia Medical University (approval number: EFY20240043) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki, all patients provided written informed consent for participation and the use of their data in the study. \u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eContributor information*:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShangfei Jing, E-mail: [email protected].\u003c/p\u003e\n\u003cp\u003eJihong Wang, E-mail: 2503455372\u003cu\[email protected]\u003c/u\u003e.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHiatt SV, Begonia MT, Thiagarajan G, et al. Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures[J]. J Hand Surg Am, 2015, 40(8):1586-1590. DOI: 10.1016/j.jhsa.2015.03.035.\u003c/li\u003e\n\u003cli\u003eGalbraith JG, Huntington LS, Borbas P, et al. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures[J]. J Hand Surg Eur Vol, 2022, 47(2):172-178. DOI: 10.1177/17531934211017705.\u003c/li\u003e\n\u003cli\u003eCheah AE, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations[J]. J Hand Surg Am, 2016, 41(6):712-722. DOI: 10.1016/j.jhsa.2016.03.007.\u003c/li\u003e\n\u003cli\u003eAllen ST, Wang OJ, Erickson LO, et al. Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures[J]. Hand (N Y), 2023, 18(1):61-66. DOI: 10.1177/15589447211003181.\u003c/li\u003e\n\u003cli\u003eKamath JB, Vardhan H, Naik DM, et al. Modified bone tie: a new method to achieve interfragmentary compression in unstable oblique metacarpal and phalangeal fractures[J]. Tech Hand Up Extrem Surg, 2012, 16(1):42-44. DOI: 10.1097/BTH.0b013e3182388278.\u003c/li\u003e\n\u003cli\u003eShe Y, Xu Y. Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing[J]. BMC Musculoskelet Disord, 2017, 18(1):238. DOI: 10.1186/s12891-017-1592-3.\u003c/li\u003e\n\u003cli\u003eWong VW, Higgins JP. Evidence-Based Medicine: Management of Metacarpal Fractures[J]. Plast Reconstr Surg, 2017, 140(1):140e-151e. DOI: 10.1097/PRS.0000000000003470.\u003c/li\u003e\n\u003cli\u003eKosugi K, Zenke Y, Tajima T, et al. Long-term outcomes of metacarpal fractures surgically treated using bioabsorbable plates: a retrospective study[J]. BMC Musculoskelet Disord, 2020, 21(1):817. DOI: 10.1186/s12891-020-03841-x.\u003c/li\u003e\n\u003cli\u003eKlein DM, Belsole RJ. Percutaneous treatment of carpal, metacarpal, and phalangeal injuries[J]. Clin Orthop Relat Res, 2000, (375):116-125. DOI: 10.1097/00003086-200006000-00014.\u003c/li\u003e\n\u003cli\u003ePanthi S, Shrestha R, Pradhan J, et al. Open Reduction and Internal Fixation with Mini-plate and Screws for Management of Unstable Metacarpal Fracture among Hand Injuries in a Tertiary Care Center: A Descriptive Cross-sectional Study[J]. JNMA J Nepal Med Assoc, 2021, 59(239):653-656. DOI: 10.31729/jnma.6846.\u003c/li\u003e\n\u003cli\u003ePage SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures[J]. J Hand Surg Am, 1998, 23(5):827-832. DOI: 10.1016/S0363-5023(98)80157-3.\u003c/li\u003e\n\u003cli\u003eHenry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization[J]. J Am Acad Orthop Surg, 2008, 16(10):586-595. DOI: 10.5435/00124635-200810000-00004.\u003c/li\u003e\n\u003cli\u003eSingh R, Sharma PK, Verma V, et al. Functional and Radiological Outcomes of Miniature Plate Osteosynthesis in Metacarpal and Phalangeal Fractures of Hand: A Prospective Study[J]. Cureus, 2024, 16(4):e58759. DOI: 10.7759/cureus.58759.\u003c/li\u003e\n\u003cli\u003eTrevisan C, Morganti A, Casiraghi A, et al. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws[J]. Arch Orthop Trauma Surg, 2004, 124(10):675-680. DOI: 10.1007/s00402-004-0745-7.\u003c/li\u003e\n\u003cli\u003eWu T, Zhang Y, Yang X, et al. Percutaneous reduction and fixation technique for 4th metacarpal shaft fracture[J]. Hand Surg Rehabil, 2021, 40(5):614-621. DOI: 10.1016/j.hansur.2021.05.013.\u003c/li\u003e\n\u003cli\u003eGummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery[J]. BMC Musculoskelet Disord, 2003, 4:11. DOI: 10.1186/1471-2474-4-11.\u003c/li\u003e\n\u003cli\u003eSletten IN, Hellund JC, Olsen B, et al. Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients[J]. J Hand Surg Eur Vol, 2015, 40(1):76-83. DOI: 10.1177/1753193414560119.\u003c/li\u003e\n\u003cli\u003eHawthorne G, Sansoni J, Hayes L, et al. Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates[J]. J Clin Epidemiol, 2014, 67(5):527-537. DOI: 10.1016/j.jclinepi.2013.12.010.\u003c/li\u003e\n\u003cli\u003eDreyfuss D, Allon R, Izacson N, et al. A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures[J]. Hand (N Y), 2019, 14(1):27-33. DOI: 10.1177/1558944718798854.\u003c/li\u003e\n\u003cli\u003eGreene TL, Noellert RC, Belsole RJ, et al. Composite wiring of metacarpal and phalangeal fractures[J]. J Hand Surg Am, 1989, 14(4):665-669. DOI: 10.1016/0363-5023(89)90188-3.\u003c/li\u003e\n\u003cli\u003eKamath JB, Jayasheelan N, Savur A, et al. Outcome of unstable fractures of metacarpal and phalangeal bones treated by bone tie[J]. Indian J Orthop, 2016, 50(3):316-321. DOI: 10.4103/0019-5413.181796.\u003c/li\u003e\n\u003cli\u003eFan XL, Wang J, Zhang DH, et al. The Use of Nice Knots Cerclage to Aid Reduction and Fixation of Metacarpal Fractures[J]. Plast Reconstr Surg, 2021, 148(2):338e-339e. DOI: 10.1097/PRS.0000000000008182.\u003c/li\u003e\n\u003cli\u003eBr\u0026uuml;ser P, Krein R, Larkin G. Fixation of metacarpal fractures using absorbable hemi-cerclage sutures[J]. J Hand Surg Br, 1999, 24(6):683-687. DOI: 10.1054/jhsb.1999.0296.\u003c/li\u003e\n\u003cli\u003eSammut D, Evans D. The Bone Tie. A new device for interfragmentary fixation[J]. J Hand Surg Br, 1999, 24(1):64-69. DOI: 10.1016/s0266-7681(99)90035-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Metacarpal Fracture, Reduction, Fixation, Tie, Plate","lastPublishedDoi":"10.21203/rs.3.rs-7495458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7495458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe aim of this study is to evaluate the clinical value of a novel tie assisted open reduction and internal fixation for the treatment of metacarpal fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 8 cases of metacarpal fractures were treated with novel tie assisted open reduction plate and screw internal fixation. We evaluated the results based on the complications, fracture healing time, return to work time, grip strength, range of motion of the metacarpophalangeal joint (MCP), disability of the arm, shoulder, and hand (DASH) score, visual analogue scale (VAS) score, and patient satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean operative time was 38.5 minutes, the mean intraoperative blood loss was 23.13 mL, the mean times of fluoroscopies was 3.5, and all patients achieved anatomic reduction or near-anatomic reduction. The mean follow-up time was 7.5 months. All patients achieved fracture healing and the mean bone union time was 7.5 weeks. The mean DASH score was 2.29, the mean VAS score was 0.5, the mean ROM of the MCP was 96.75% and the mean grip strength was 97.88% of the healthy finger, and the mean time to return to work was 8.5 ± 2.07 weeks. According to the Short Assessment of Patient Satisfaction, 7 cases were very satisfied and 1 case was satisfied. There were no complications such as infection, tendon injury, loosening, slipping, breaking or even loss of fracture reduction related to the the tie.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe novel tie is a convenient, efficient and safe means of assisted reduction and fixation of metacarpal fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e","manuscriptTitle":"A Novel Tie to Assist Metacarpal Fracture Reduction and Fixation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 02:34:55","doi":"10.21203/rs.3.rs-7495458/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b308d067-dbb4-491d-a85b-472ef3868f46","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T10:53:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 02:34:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7495458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7495458","identity":"rs-7495458","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}