Abstract
BackgroundWe reviewed our results and complications of using a pre-bent 1.6 mm Kirschner wire (K-wire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity.MethodsA single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimeters and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5 mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint.The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic.ResultsWe studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days). All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks). At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment.ConclusionsWith this simple and minimally invasive technique performed as day-case surgery, all patients were able to start mobilisation immediately. The general outcome was good hand function with few complications.
Highlights
Hand injuries are very common resulting frequently in metacarpal and phalangeal fractures [1]
Though a majority of these fractures can be treated non-operatively, surgical intervention is indicated for certain intra-articular fractures, displaced and angulated fractures, rotational deformity, multiple injuries, irreducible and unstable dislocations; and those associated with significant soft tissue injury
We describe a technique and results of using a single pre-bent Kirschner wire (Kwire) for extra-articular metacarpal fractures
Summary
Hand injuries are very common resulting frequently in metacarpal and phalangeal fractures [1]. Various fixation techniques in use are percutaneous pinning, cerclage wiring, plating, lag screws, tension band wires and external fixators [2,7,8,9,10,11,12,13,14,15,16]. Of these Kirschner wire (K-wire) fixation is a popular choice due to the simplicity of the procedure and the minimal soft tissue interference [17]. We describe a technique and results of using a single pre-bent Kirschner wire (Kwire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity
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