Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures

Abstract

The purpose of this prospective study was to evaluate the functional and radiographic outcomes of our new surgical technique, retrograde percutaneous intramedullary multiple Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal neck or shaft fractures. Between March 2005 and April 2010, 56 consecutive patients with 65 metacarpal fractures were treated with closed reduction and retrograde intramedullary fixation with at least 2 K-wires. The average follow-up duration was 13 months. The clinical outcome was assessed by the total active motion (TAM) of the digit, presence of rotational deformity, grip strength, patient satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. The radiographic outcome was assessed by the time to union, dorsal angulation, and shortening. The average operating time was 11 min (range, 6-17 min) for isolated single metacarpal fractures and 18 min (range, 13-25 min) for isolated simultaneous 2-metacarpal fractures. There was no significant difference in the average TAM of the digit between the injured and uninjured hands in both neck and shaft fractures. Four patients developed extensor tendon irritation during follow-up, but the irritations disappeared completely after removal of the wires, and there was no need to perform tenolysis. The average DASH score was 8.7 (range, 0-21). Radiographic union was achieved in all patients at a mean of 5.2 weeks. Radiographic assessment revealed a significant reduction in the average dorsal angulation to 8° (SD, 2) in neck fractures and to 4° (SD, 2) in shaft fractures postoperatively. The average shortening was corrected significantly to 1 mm (SD, 2) in neck fractures and to -1 mm (SD, 2) in shaft fractures postoperatively. Based on our experience, our retrograde intramedullary K-wire fixation technique is an acceptable alternative modality for the treatment of unstable displaced metacarpal fractures. This straightforward technique can facilitate early hand mobilization, correct the deformity, and provide good clinical and radiographic outcomes.