Background: Several methods of fixing unstable metacarpal shaft
fractures have been described; the aim of the study was to assess the
clinical and radiological results of transverse Kirschner (K)-wire
fixation technique for treatment of unstable ulnar four metacarpal
fractures.
Patients and Methods: A prospective study held between 2014 and
2016 at Benha University Hospital on 25 patients (22 males and 3
females) had unstable metacarpal fractures affecting second to fifth
metacarpals treated with transverse wiring technique. The patient’s
mean age was 30.9 years. The dominant hand was affected in 21
patients while in 4 patients the non-dominant hand was affected.
Under fluoroscopy, closed reduction and percutaneous fixation with
three K-wires, one proximal and two distal to the fracture site. The
mean operative time was 28.8 minutes. The inclusion criteria
included patients with acute metacarpal shaft fracture with
unaccepted shortening, angulation and rotation.
Results The mean follow-up period was 12.1 months. Bony union
achieved at an average of 6.8 weeks.At the final follow-up, all
patients had almost full ROM with a mean total active range of
motion 260° (245°- 270°). None of the patients had any clinically
detectable rotational deformity, functional outcome was satisfactory
with mean grip strength of the injured hand 97% in comparison to
the non-injured side, average Quick Dash score was 1.5 (± 1.6)
ranging from zero to 4.5 points. The mean VAS for pain was 0.92 (±
1.1). All patients returned to their ordinary jobs and were
cosmetically and functionally satisfied with the results of their
surgery. Two patients presented superficial pin tract infection and one
patient united with 15° radiological angulation of the 5th metacarpal
without any functional affection. No other complications occurred.
Conclusion transverse k-wires technique is an effective, easy and
safe method for treating unstable metacarpal fractures, without
significant complications. |
