Treatment of unstable metacarpal fractures using transverse Kirschner-wire fixation technique

Abstract

Background Several methods of fixing unstable metacarpal shaft fractures have been described. The aim of the study was to assess the clinical and radiological results of transverse Kirschner (K)-wire fixation technique for the treatment of unstable ulnar four metacarpal fractures. Patients and methods A prospective study was held between 2014 and 2016 at Benha University Hospital on 25 patients (22 males and three females) who had unstable metacarpal fractures affecting second to fifth metacarpals treated with transverse wiring technique. The patients’ mean age was 30.9 years. The dominant hand was affected in 21 patients, whereas in four patients, the nondominant hand was affected. Under fluoroscopy, closed reduction and percutaneous fixation with three K-wires, one proximal and two distal to the fracture site, was done. The mean operative time was 28.8 min. The inclusion criteria included patients with acute metacarpal shaft fracture with unaccepted shortening, angulation, and rotation. Results The mean follow-up period was 12.1 months. Bony union was achieved at an average of 6.8 weeks. At the final follow-up, all patients had almost full range of motion, with a mean total active range of motion of 260° (245–270°). None of the patients had any clinically detectable rotational deformity, and the functional outcome was satisfactory, with mean grip strength of the injured hand of 97% in comparison with the noninjured side. The average Quick Dash score was 1.5±1.6, ranging from 0 to 4.5 points. The mean visual analog score for pain was 0.92±1.1. All patients returned to their ordinary jobs and were cosmetically and functionally satisfied with the results of their surgery. Two patients presented with superficial pin-tract infection and one patient united with 15° radiological angulation of the fifth metacarpal without any functional affection. No other complications occurred. Conclusion Transverse K-wire technique is an effective, easy, and safe method for treating unstable metacarpal fractures, without significant complications.