Abstract
BackgroundThis study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals.MethodsTwenty patients treated by the abovementioned modified technique (modified technique group) and ten patients treated by the traditional percutaneous K-wire fixation technique (traditional technique group) from October 2015 to November 2019 at our institution were retrospectively reviewed. The patients’ average age was 38 years (range, 16–61 years). The mean follow-up period was 13 months (range, 10–18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared between the modified and traditional technique groups. In addition, the functional recovery of the injured hand was compared with that of the uninjured hand within the modified technique group.ResultsAll patients recovered well, with no cases of infection or nonunion. Compared with the traditional technique group, the modified technique group had a shorter operative time, lower postoperative visual analogue scale pain score, better effective range of motion score of the first carpometacarpal joint (Kapandji score), and had almost no need for auxiliary plaster fixation, enabling functional exercise to be started earlier. Within the modified technique group, the mean hand grip strength, pinch strength, and Kapandji score on the injured side did not significantly differ to the values on the uninjured side in both the extra-articular and intra-articular fracture subgroups. While the abduction and flexion–extension arcs of the thumb on the injured hand were significantly smaller than those on the uninjured hand in both the extra-articular and intra-articular fracture subgroups, the patients felt clinically well with respect to daily activities and strength.ConclusionThe percutaneous parallel K-wire and interlocking fixation technique is simple, effective, and economical for first metacarpal base fractures.
Highlights
This study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel Kirshner wire (K-wire) interlocking fixation between the first and second metacarpals
First metacarpal base fractures account for 80% of thumb fractures and 20% of fractures involving the articular surface of the first carpometacarpal joint [1]
Wagner’s method is a classic technique of closed reduction and percutaneous K-wire fixation for Bennett fractures [4]; it can be used for Rolando fractures [5]
Summary
This study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals. First metacarpal base fractures account for 80% of thumb fractures and 20% of fractures involving the articular surface of the first carpometacarpal joint [1]. These fractures are generally classified into four types: extra-articular, Bennett, Rolando, and comminuted [2]. Percutaneous cross K-wire fixation is often used for Rolando fractures and extraarticular fractures of the first metacarpal base [5, 6] These procedures require placement of a Kwire across the first carpometacarpal joint to fix the first metacarpal with the trapezium, which may increase the risk of traumatic arthritis [7]. The end of the K-wire is not fixed in these techniques, which cannot prevent rotation and loosening of the K-wire, which often leads to secondary displacement [8]
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