Arch Hand Microsurg.  2018 Sep;23(3):175-183. 10.12790/ahm.2018.23.3.175.

The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation

• Hong SW
• Lee YH
• Kim MB
• Baek GH

• KMID: 2419452
• DOI: http://doi.org/10.12790/ahm.2018.23.3.175

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.

Keyword

Metacarpal neck; Metacarpal shaft; Comminuted fracture; Retrograde; Intramedullary nailing

MeSH Terms

Follow-Up Studies
Fracture Fixation, Intramedullary
Fractures, Comminuted*
Humans
Metacarpophalangeal Joint
Methods
Neck*
Physical Examination
Range of Motion, Articular
Visual Analog Scale

Figure

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  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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