Journal List > J Korean Orthop Assoc > v.51(4) > 1013463

Kim, Lee, Kong, Kim, Park, and Jung: Comparison of Intramedullary K-Wire Nailing versus Plate for Fixation in Metacarpal Midshaft Fracture

Abstract

Purpose

The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates.

Materials and Methods

This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically.

Results

Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups.

Conclusion

Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.

Figures and Tables

Figure 1

(A) Preoperative radiographs of the 4th metacarpal midshaft fracture. (B) Immediate postoperative radiographs.

jkoa-51-338-g001
Figure 2

Examples of metacarpal midshaft fracture following surgery using internal fixation of plate. (A) A 35-year-old man had a 4th metacarpal midshaft fracture due to slip down. (B) Internal fixation was performed.

jkoa-51-338-g002
Table 1

Comparison of Factors of the Patients Who Had Surgery Using Intramedullary K-Wire Nailing and Internal Fixation of Plates

jkoa-51-338-i001

Values are presented as median (range) or number (%).

Table 2

Postoperative Data of Patients Who Had Surgery Using Intramedullary K-Wire Nailing and Internal Fixation of Plates

jkoa-51-338-i002

Values are presented as mean (range). DASH, disabilities of the arm, shoulder and hand; VAS, visual analogue scale.

Notes

Joo-Yong Kim's current affiliation: Department of Orthopedic Surgery, Busan Korea Hospital, Busan, Korea.

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury. 1994; 25:365–369.
crossref
2. Viegas SF, Tencer A, Woodard P, Williams CR. Functional bracing of fractures of the second through fifth metacarpals. J Hand Surg Am. 1987; 12:139–143.
crossref
3. Jones AR. A custom brace for treatment of angslated fifth metacarpal fractures. J Hand Surg Am. 1996; 21:319–320.
4. McKerrell J, Bowen V, Johnston G, Zondervan J. Boxer's fractures--conservative or operative management? J Trauma. 1987; 27:486–490.
crossref
5. Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma. 2003; 55:509–513.
crossref
6. O'Sullivan ST, Limantzakis G, Kay SP. The role of low-profile titanium miniplates in emergency and elective hand surgery. J Hand Surg Br. 1999; 24:347–349.
7. Fusetti C, Meyer H, Borisch N, Stern R, Santa DD, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma. 2002; 52:535–539.
crossref
8. Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005; 87:1038–1046.
9. Burkhalter WE. Closed treatment of hand fractures. J Hand Surg Am. 1989; 14:390–393.
crossref
10. Freeland AE, Jabaly ME, Hughes JL. Stable fixation of hand and wrist. New York: Spinger-Verlag;1986. p. 58.
11. Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin. 2013; 29:507–518.
crossref
12. Lord RE. Intramedullary fixation of metacarpal fractures. J Am Med Assoc. 1957; 164:1746–1749.
crossref
13. Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995; 20:S86–S90.
crossref
14. Palibrk TD, Lesić AR, Andjelković SZ, et al. Operative treatment of metacarpal and phalangeal fractures with Kirschner wire fixation--a review. Acta Chir Iugosl. 2013; 60:49–52.
15. Mohammed R, Farook MZ, Newman K. Percutaneous elastic intramedullary nailing of metacarpal fractures: surgical technique and clinical results study. J Orthop Surg Res. 2011; 6:37.
crossref
16. Gonzalez MH, Igram CM, Hall RF Jr. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am. 1995; 20:382–387.
crossref
17. Blazar PE, Leven D. Intramedullary nail fixation for metacarpal fractures. Hand Clin. 2010; 26:321–325.
crossref
18. Orbay J. Intramedullary nailing of metacarpal shaft fractures. Tech Hand Up Extrem Surg. 2005; 9:69–73.
crossref
19. Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am. 1985; 10:466–472.
crossref
20. Bosscha K, Snellen JP. Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study. Injury. 1993; 24:166–168.
crossref
21. Mumtaz MU, Farooq MA, Rasool AA, Kawoosa AA, Badoo AR, Dhar SA. Unstable metacarpal and phalangeal fractures: treatment by internal fixation using AO mini-fragment plates and screws. Ulus Travma Acil Cerrahi Derg. 2010; 16:334–338.
22. Takigami H, Sakano H, Saito T. Internal fixation with the low profile plate system compared with Kirschner wire fixation: clinical results of treatment for metacarpal and phalangeal fractures. Hand Surg. 2010; 15:1–6.
crossref
23. Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res. 2010; 96:506–512.
crossref
24. Xu J, Zhang C. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis. J Orthop Surg Res. 2014; 9:24.
crossref
25. Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg. 1997; 99:1079–1083.
crossref
TOOLS
Similar articles