Journal List > Arch Hand Microsurg > v.23(3) > 1106621

Hong, Lee, Kim, and Baek: The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation

Abstract

Purpose

The purpose of the present study was to verify the therapeutic efficiency of modified percutaneous retrograde intramedullary fixation using Kirschner wire in metacarpal shaft and neck comminuted fractures.

Methods

A total of 17 cases in 15 patients with metacarpal shaft and neck comminuted fractures diagnosed by physical examination and imaging modalities were included. For radiologic evaluations, the changes of degree of metacarpal bone shortening and that of dorsal angulation of metacarpal bone between before and six months after surgery were measured. Clinical evaluations were assessed by the timing of clinical union and visual analog scale (VAS), total active range of motion (TAM) of metacarpophalangeal joint, and complications at six months postoperatively.

Results

In all cases, union was achieved without additional treatment. The degree of the metacarpal bone shortening and the degree of dorsal angulation of metacarpal bone were improved significantly at six months after operation. The clinical bone union was completed average 6.49 weeks after surgery. The mean VAS was 1.35, and the mean TAM of metacarpophalangeal joint was 85.88° at 6 months postoperatively. Complications including nonunion, malunion, and refracture were not observed during follow-up period.

Conclusion

Modified percutaneous retrograde intramedullary fixation using Kirschner wire showed satisfactory treatment results in metacarpal shaft and neck comminuted fractures. Thus, this method could be recommended as one of treatment modalities for metacarpal shaft and neck comminuted fractures due to its easy procedures and low occurrence rate of associate complications.

Figures and Tables

Fig. 1

(A) Wires were inserted retrogradely using a mallet at a maximal wrist flexed position. (B) The surgeon moved the Kirschner wire to proximal side using mallet and vice grip.

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Fig. 2

(A) Pre-operative true antero-posterior radiograph of the involved right hand of 27-year-old man with comminuted 2nd metacarpal neck fracture. (B) Pre-operative oblique radiograph of the hand with metacarpal neck fracture which showed dorsal angulation. (C, D) Antero-posterior and lateral view of radiographs taken immediately after operation which showed satisfactory fracture reduction. (E, F) Six-month postoperatively taken radiograph showed that complete bony union was achieved with acceptable alignment. (G, H) The patient fully recovered the range of motion of the involved hand at 6 months after the operation.

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Fig. 3

(A, B) Pre-operative true antero-posterior and oblique radiograph of the involved left hand of 80-year-old man with comminuted 3rd metacarpal shaft fracture. (C, D) Anteroposterior and lateral view of radiographs taken immediately after operation which showed satisfactory fracture reduction. (E, F) One-year postoperatively taken radiograph showed that complete bony union was achieved with acceptable alignment.

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Table 1

Demographic data of patients

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M: male, F: female.

*Type of fracture classified according to Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association fracture and dislocation classification compendium – 2018.

Table 2

The diameter and number of intramedullary Kirschner wires used in present study

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Table 3

Average dorsal angulation and shortening of metacarpal bone

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Values are presented as mean±standard deviation.

Data obtained from Wilcoxon signed rank test.

*p<0.001 by Wilcoxon signed rank test.

Table 4

Average period of clinical bony union and the pain VAS and TAM of metacarpophalangeal joint 6-month after surgery

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Values are presented as mean±standard deviation.

VAS: visual analog scale, TAM: total active motion.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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