J Korean Soc Surg Hand.  2017 Jun;22(2):105-111. 10.12790/jkssh.2017.22.2.105.

Clinical Study on Percutaneous Intramedullary Bioresorbable Pin Fixation for Fourth and Fifth Metacarpal Bone Fracture

• Lee SH
• Kim SH
• Park ES
• Nam SM
• Shin HS

• KMID: 2383802
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.105

Abstract

PURPOSE
Metacarpal fracture of a ring and little finger occurs frequently. Percutaneous intramedullary fixation is a simple and effective method with a low incidence of complications. To date, Kirschner wire (K-wire) fixation has been widely used, but this has problems such as pin infection. Moreover it is difficult to start early active motion exercise. So, we replaced the K-wire with a bioresorbable implant and evaluated the results.
METHODS
This study was conducted from 2014 to 2016 and involved 10 consecutive patients with 10 metacarpal neck fractures. All cases underwent percutaneous intramedullary fixation using the ActivaPin (Bioretec Ltd.) within 7 days after injury, and the average follow-up period was 13 months. At the final follow-up, all cases were assessed in terms of total active motion (TAM), bony union and angular deformity based on plain radiographs.
RESULTS
The patients started active motion exercise within 1 week and regained a full range of motion after average 4 weeks. The TAM results were excellent at 250° to 270° in all cases. Regarding radiographic findings, fractures united in all cases and there were no malunion and knuckle deformity.
CONCLUSION
Replacement of a K-wire with a bioresorbable pin prevented soft tissue damage and dorsal scarring. And our percutaneous intramedullary bioresorbable pin fixation technique resulted in early recovery of range of motion and correction of deformity. The patients regained range of motion and returned to daily life early.

Keyword

Absorbable implants; Fracture fixation; Metacarpal bones

MeSH Terms

Absorbable Implants
Cicatrix
Clinical Study*
Congenital Abnormalities
Fingers
Follow-Up Studies
Fracture Fixation
Fractures, Bone*
Humans
Incidence
Metacarpal Bones
Methods
Neck
Range of Motion, Articular

Figure

• 

  Fig. 1 ActivaPin (2.0 mm×70.0 mm; Bioretec Ltd.) has grooved surface design, and it contributed to a self-locking effect with the adjacent the bone.

• 

  Fig. 2 The ActivaPin (Bioretec Ltd.) device. (A) ActivaPin guide Kirschner wire was used to produce an accurate hole at the site of the ActivaPin. (B) ActivaPin cutter cut the ActivaPin 2 mm shorter than inserted guided pin length. (C) ActivaPin piston (upper) attached ActivaPin and slide inside the ActivaPin sleeve (lower).

• 

  Fig. 3 Intraoperative photograph. To produce an accurate hole where the ActivaPin (arrow; Bioretec Ltd.) is located, a Kirschner wire is inserted percutaneously into the intramedullary canal with flexion of the metacarpophalangeal joint.

• 

  Fig. 4 Preoperative clinical photograph and simple radiograph. (A–C) Preoperative photographic and X-ray findings of a 32-year-old male with a fifth metacarpal neck fracture. (D, E) X-ray at 1 day postoperatively showing a percutaneous intramedullary bioresorbable pin fixation state. (F, G) At 6 months after the operation, radiographs show bony union without dorsal angulation.

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