Metacarpal Shaft Fractures Research Articles

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

BackgroundMetacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure.ObjectiveTo evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires.Materials and methodsWe used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force–displacement data. The Mann–Whitney U test was used to compare between-group differences in maximum fracture force and stiffness.ResultsThe maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p < 0.05; Figure 5a), with the median of the KP&F8 group exceeding that of the KP group by 57.5%. Similarly, stiffness was significantly lower in the KP group (18.14 ± 9.84 N/mm) than in the KP&F8 group (38.25 ± 23.49 N/mm; p < 0.05; Figure 5b), with the median of the KP&F8 group exceeding that of the KP group by 110.9%.ConclusionThe incorporation of a figure-of-eight cerclage wire increased the maximum fracture force and stiffness by 57.5 and 110.9%, respectively, compared with those achieved in standard two K-wire fixation. Therefore, hand surgeons are advised to consider the proposed approach to increase fixation strength.

A Single Intramedullary K-Wire Is Sufficient for the Management of Nonthumb Metacarpal Shaft Fractures.

Objective This study aims to evaluate the outcome after the internal fixation of diaphyseal metacarpal fractures by a single intramedullary K-wire. Methods In this prospective case series study, conducted from July 2017 to June 2019 in 23 adult patients with a single, unstable, diaphyseal metacarpal fracture, outcomes after internal surgical fixation using a single antegrade intramedullary K-wire were evaluated. The outcomes were evaluated by union rate, time to union, handgrip measurements at 6 and 12 months, and the modified Disabilities of the Arm, Shoulder, and Hand (DASH) score at 12 months. Results The study population consisted of 17 males and 6 females, with a mean patient age of 28.4 ± 8.5 years (range, 16–45 years). The median time to final follow-up was 14 ± 1.8 months (range: 12–24 months). The mean duration of the union was 7.3 ± 1.6 weeks (range: 5–11 weeks), with a union rate of 95.7% (22 cases). The mean handgrip strength was 68% ± 12.8% of the strength of the uninjured hand after 6 months and 92.7% ± 6.9% after 12 months. The mean modified DASH score was 2.6 ± 0.26 after 12 months (range: 0–5.8). There were no cases of malrotation or infection. In conclusion, using a single 1.8–2.0 mm K-wire gives excellent functional outcomes and union rate without significant complications when used to treat an unstable metacarpal shaft fracture.

Incidence of Loss of Reduction After Open Reduction Internal Fixation of Metacarpal Shaft Fractures.

This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR. We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. We compared the incidence of LOR between the screw and plate groups using a χ2 test. We performed logistic regression analysis to determine whether patient age, sex, metacarpal location (index, long, ring, small), the presence of multiple metacarpal fractures, or fracture pattern were associated with increased incidence of LOR. Loss of reduction occurred in 19 (13.8%) of 138 fractures, with no statistically significant difference between lag screw (7 of 60, 11.6%) and plate fixation (12 of 78, 15.4%). Neither fracture pattern nor the presence of multiple metacarpal fractures was associated with an increased incidence of LOR, but patients experienced a 7% increase in the risk of LOR for each additional year of age. Loss of reduction occurred most frequently in index metacarpal fractures (4 of 12, 33%), although this did not reach statistical significance. We found no difference in LOR incidence between lag screw fixation and plate fixation. The overall incidence of LOR was higher in this study than previously reported and increased with increasing patient age.

Metacarpal shaft fixation: a biomechanical comparison of dorsal plating, lag screws, and headless compression screws

BackgroundMetacarpal shaft fractures are common and can be treated nonoperatively. Shortening, angulation, and rotational deformity are indications for surgical treatment. Various forms of treatment with advantages and disadvantages have been documented. The purpose of the study was to determine the stability of fracture fixation with intramedullary headless compression screws in two types of metacarpal shaft fractures and compare them to other common forms of rigid fixation: dorsal plating and lag screw fixation. It was hypothesized that headless compression screws would demonstrate a biomechanical stronger construct.MethodsFive matched paired hands (age 60.9 ± 4.6 years), utilizing non-thumb metacarpals, were used for comparative fixation in two fracture types created by an osteotomy. In transverse diaphyseal fractures, fixation by headless compression screws (n = 7) and plating (n = 8) were compared. In long oblique diaphyseal fractures, headless compression screws (n = 8) were compared with plating (n = 8) and lag screws (n = 7). Testing was performed using an MTS frame producing an apex dorsal, three point bending force. Peak load to failure and stiffness were calculated from the load-displacement curve generated.ResultsFor transverse fractures, headless compression screws had a significantly higher stiffness and peak load to failure, means 249.4 N/mm and 584.8 N, than plates, means 129.02 N/mm and 303.9 N (both p < 0.001). For long oblique fractures, stiffness and peak load to failure for headless compression screws were means 209 N/mm and 758.4 N, for plates 258.7 N/mm and 518.5 N, and for lag screws 172.18 N/mm and 234.11 N. There was significance in peak load to failure for headless compression screws vs plates (p = 0.023), headless compression screws vs lag screws (p < 0.001), and plates vs lag screws (p = 0.009). There was no significant difference in stiffness between groups.ConclusionIntramedullary fixation of diaphyseal metacarpal fractures with a headless compression screw provides excellent biomechanical stability. Coupled with lower risks for adverse effects, headless compression screws may be a preferable option for those requiring rapid return to sport or work.Level of evidenceBasic Science Study, Biomechanics.

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

A Prospective Study of Closed Comminuted Osteoporotic Metacarpal Shaft Fractures Treated with Locking Mini Plates in a Tertiary Care Hospital

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

BackgroundMetacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage.ObjectiveWe propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture.Materials and methodsWe used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups.ResultsThe maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively.ConclusionHeadless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Comparative Study Between Intramedullary K Wires Versus Mini-plates and Screws in Fixation of Metacarpal Shaft Fractures in Adults

Abstract Background: Percutaneous intramedullary K. wires fixation and mini-plates fixation are reasonable options for treating unstable metacarpal fractures as they provide anatomical reduction and rigid fixation, which is adequate to permit early mobilization. Objective: To compare between mini-plates and Kirschner wires in management of unstable metacarpal shaft fractures in adults. Patients and Methods: All patients (n=30) included in this prospective comparative study were managed and followed up at Al-Azhar University Hospital from January 2019 to February 2020. Thirty patients with fracture of shaft metacarpal were divided into 2 groups: group A (n=15) were managed by percutaneous intramedullary K-wires and group B (n=15) were managed by mini-plates. Results:27 Patients were males and 3 were females . Dominant hand affection were in 20 patients . All patients had a complete union between 4-8 weeks for group A with average of 6 weeks and 6-10 weeks for group B with average of 8 weeks. The total result according to TAF score, Quick DASH score, and handgrip was excellent in 10 cases, good in 4 cases, and fair in 1 case in group A, while group B was excellent in 10 cases, good in 3 cases, fair in 1 case and poor in 1 case. Conclusion: Both techniques are highly effective for fixation of metacarpal shaft fractures. Mini-plate fixation provides rapid recovery of hand function and K-wire fixation allows a wide range of hand motion and soft tissue preservation.

Evaluation of Antegrade Intramedullary Compression Screw Fixation of Metacarpal Shaft Fractures in a Cadaver Model

Surgical options for displaced metacarpal shaft fractures include the use of Kirschner wires, plates and screws, and most recently, intramedullary headless compression screws (IMHCS), which have been reported using only retrograde insertion through the metacarpal head. We evaluated IMHCS fixation of metacarpal shaft fractures through an antegrade approach in a cadaver model. We performed antegrade placement of IMHCS in 10 cadaver hands including all 5 digits (total of 50). Displaced transverse proximal metacarpal shaft fractures were created and reduced with a retrograde guidewire from the metacarpal head across the shaft fracture andexiting the metacarpal base. This was retrieved through a 6-mm dorsal wrist incision and overdrilled before the placement of a 4.1-mm-diameter IMHCS in the ring finger and a 4.7-mm screw in all other metacarpals. After IMHCS placement, carpometacarpal (CMC) joint violation was measured along with the optimal starting point for the guidewire on the metacarpal head relative to the dorsal cortex. In all 50 metacarpals, we achieved successful fracture reduction and fixation without violating the extensor mechanism at the wrist. Our retrograde guidewire entry point through the metacarpal head ranged from 4.2 to 4.7 mm volar to the dorsal cortex. The actual area of CMC joint violated by IMHCS placement was largest in the index CMC joint (4.9%), followed by the middle (3.7%), little (2.9%), ring (0.5%), and thumb joints (0.2%). Placement of IMHCS through an antegrade approach from the CMC joint can be performed effectively for all transverse metacarpal fractures, including the thumb, using a limited incision. There is minimal violation of the articular surfaces of the trapezium, capitate, and hamate for the thumb, middle, ring, and little metacarpals. Antegrade IMHCS fixation successfully avoids the potential morbidity of creating a metacarpal head articular surface or extensor mechanism defect at the metacarpophalangeal joint seen with the retrograde approaches.

Single Antegrade Intramedullary Kirschner Wire Fixation For Transverse Metacarpal Shaft Fractures: A Retrospective Review

Introduction: Fractures of the metacarpals are frequently encountered. Transverse metacarpal shaft fractures are inherently unstable and amenable to surgical intervention. Few studies have evaluated outcomes of patients with a singular transverse metacarpal shaft fracture surgically corrected with an antegrade intramedullary Kirschner (K) wire. We present our series of patients and their outcomes performed by a single surgeon. Materials and Methods: A retrospective chart review of cases at our institution was performed on transverse metacarpal fracture treated with an intramedullary K-wire. Fifteen patients met the inclusion criteria. Data extracted included metacarpal involved, laterality, sex, age, if removal of hardware was performed, time from initial injury to surgery, tourniquet time, complications, range of motion, clinical outcome, among others. Results: All fractures occurred about the right hand with 7 involving the small finger metacarpal, 4 involving the index, 3 involving the ring, and 1 involving the middle. The average patient age was 25 years (range: 18 to 58 y). The average tourniquet time was 16 minutes (range: 10 to 20 min). There were no intraoperative complications and 1 patient had hardware removed at 8 weeks due to proximal pin site pain. All patients achieved clinical union with a return of full function. Discussion: Single antegrade intramedullary K-wire fixation is a simple, reliable, and potentially cost-effective treatment option for transverse metacarpal shaft fractures. Further research is needed to determine long-term outcomes and formal cost analysis. Our series indicate this technique can be safely utilized, with a low risk of complications and good clinical outcomes. Level of Evidence: Level IV—therapeutic.

A Systematic Review of Treatment Interventions for Metacarpal Shaft Fractures in Adults.

Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. A comprehensive search was conducted across multiple databases, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1600 records were identified; 7 studies fulfilled eligibility criteria and were included. No randomized controlled trials directly comparing surgery with nonsurgical treatment were found. One retrospective study compared nonsurgical with surgical treatment, whereas 6 compared surgical or nonsurgical treatments. Considerable heterogeneity between studies along with a high or critical risk of bias restricts direct comparison and conclusions. There is a lack of high-quality evidence to guide treatment, supporting the need for well-designed, multicenter trials to identify the most effective and cost-efficient treatment for metacarpal shaft fractures in adults.

Ring finger metacarpal fracture iatrogenic rotation using an ulnar gutter splint: A cadaveric study

Study DesignCohort cadaveric study. IntroductionRing finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic “molding”, resulting in a crossover deformity of the ring finger over the small finger. Purpose of the StudyThe goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. MethodsTransverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. ResultsThere was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). ConclusionsApplication of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.

Biomechanical Modeling of Connecting Intermetacarpal K-Wires in the Treatment of Metacarpal Shaft Fractures.

Clinical series have been published using the configuration of 2 intercarpal Kirschner wires (K-wires) adjacent to the fracture being connected, but biomechanical analysis is lacking. The objective of this pilot biomechanical study was to model and compare the effects of externally connecting 2 intermetacarpal K-wires for the stabilization of transverse metacarpal shaft fractures. Our research hypothesis was that the connected constructs would be stiffer than the unconnected K-wires. A 3-dimensional computer-based model of small finger transverse metacarpal fracture stabilization was designed with 3 transverse 1.1 mm K-wires being anchored to the adjacent metacarpal. Three arrangements were tested: all 3 K-wires in parallel, the middle K-wire angled toward the proximal wire, and the middle angled K-wire being rigidly fixed to the proximal K-wire. The proximal wire was proximal to the fracture. A finite element analysis was performed by applying a cantilever force of 100 N at the head of the metacarpal. The metacarpal was considered to be uniform in composition with parameters typical for human bone. Kirschner wire parameters for stainless steel were used. Force (N) versus displacement was measured. The configuration with the middle angled K-wire being rigidly fixed to the proximal K-wire showed greater stiffness (12 N/mm) than nonattached constructs. The connected construct was 2.3 times more stiff than the unattached parallel construct and 2.5 times more stiff than angling the middle K-wire without attachment. In a computer model simulation, our results show that attaching 2 K-wires adjacent to the fracture provides more than twice the stiffness of unconnected K-wires.

Management of metacarpal shaft fracture with cerclage wiring and its outcome

Introduction: Hand is specialized organ of the body performing complex functions, and it enables a person to earn his livelihood. Various options are there for treatment of metacarpal shaft fractures, in this study we treated patients with cerclage wiring and noted its outcomes. Material and methods: patients who were presented with oblique/spiral fracture of shaft of metacarpal during the study period were treated with cerclage wiring and followed until they were able to return to work. Results: seven patients with eight fractures were treated during the study period. Reduction achieved was good in all patients. We had one late complication of wire breakage and no malunion or non-union occurred. Conclusion: we conclude that cerclage wiring treatment is effective method for treatment of oblique/spiral fracture of metacarpals and a viable and cheap alternative to plate and screw method in low socio-economic patients.

Clinical Outcomes of Ready-Made J-Shaped Nail Fixation for Unstable Metacarpal Fractures.

Background: The purpose of this study was to report the clinical outcomes of ready-made J-shaped intramedullary nail fixation for unstable metacarpal fractures. Methods: A total of 25 unstable fractures from 24 patients were evaluated in this retrospective study, comprising 20 metacarpal neck and 5 metacarpal shaft fractures. The mean follow-up was 22 weeks. Functional outcomes were assessed based on the range of motion of the metacarpophalangeal joint. Radiographic outcomes were evaluated by four projections of the postoperative plain radiographs at the final follow-up, and then were rated as excellent if projections at the fracture site showed no correction loss or angular deformity greater than 10°. Surgery time and complications during the treatments were recorded for each case. Results: All 25 fractures obtained bony union. The mean range of motion of the metacarpophalangeal joint was 78° (range, 45°-90°). Radiographic outcomes were excellent in 24 (96%) of 25 fractures. Only one fracture had correction loss. The mean surgery time was 29 minutes (range, 14-61 minutes). Two cases had extensor tendon adhesion at the insertion site, which was easily released when the implant was removed. Conclusions: This study demonstrates that intramedullary fixation with a ready-made J-shaped nail is a reliable treatment option for unstable metacarpal fractures.

Comparative Study between Kirschner Wires and Mini-Set Plate in Management of Unstable Metacarpal Shaft Fractures

Metacarpal fractures comprise between 18–44 % of all hand fractures. Non-thumb metacarpals account for around 88 % of all metacarpal fractures, with the fifth finger most commonly involved. This is a comparative study between Kirschner wires and mini-set plate in management of unstable metacarpal shaft fractures. This is a review article, The search was performed in MEDLINE, Embase, Pubmed and CINAHL Plus in the same date range with the following mediacl terms: “Kirschner wires; mini-set plate; unstable; metacarpal shaft; fractures.”, including articles from 2000 to 2019, K-wire fixation is simple to manipulate and without or with little damage on fracture blood supply, and has been used extensively. Since in the K-wire fixation there is no compression on the fracture, it is difficult to control the motions of the fingers. Stiffness resulting from tendon adhesions and joint contractures is the most common complication associated with hand fractures. Conversely, fractures that require mini-plate fixation but are treated without fixation or with inadequate fixation still lead to stiffness and are associated with an increased rate of nonunion and malunion. Kirschner wires are almost always used for temporary fixation and are removed after the early appearance of fracture callus on radiographs. Despite the availability of many options for fixation, percutaneous fixation using Kirschner wires is a good method for treatment of unstable ulnar four metacarpal fractures. We recommended this technique, which is more biological, technically easier, safe, cheap and rapid to perform with good functional outcome.

Functional results of osteosynthesis with mini-plate and screws in metacarpal shaft fractures

ABSTRACTBackground: Metacarpal fractures are usually managed by conservative methods, but using these conservative methods in unstable fractures usually showed poor results. Surgical intervention is recommended in this fracture types.Purposes: This study aims to assess the functional outcomes of plate fixation in metacarpal shaft fractures. The assessment was done by using Total Active Flexion score according to the American Society for Surgery of the Hand.Patient and Methods: This study was a prospective study conducted at Al-Hussein University Hospital in a period between April 2017 and November 2019. This study was conducted on a total of 20 patients diagnosed with displaced, irreducible, and unstable metacarpal shaft fractures. Miniplate and screws was used for the fractures fixation. The patient's ages varied from 20 to 50 years old.Results: The study was conducted on 20 patients, 10 patients were male (50%) and 10 were female (50%). The dominant hand was involved in 14 patients (70%). fracture union was seen in all patients. Most of them showed bone union between 8-12 weeks with an average 10 weeks. The total active flexion was measured and showed excellent scores in 14 patients, good scores in 4 patients, and fair scores only in 2 patients.Conclusion: mini-plate and screws is a good choice for unstable metacarpal fractures fixation. The use of mini-plate and screws provide rigid stable fixation which allows early hand movement and achieving good functional outcomes.Keywords: Metacarpal fractures; Mini-plate and screws; total active flexion score.

Intramedullary screw fixation for metacarpal shaft fractures: a biomechanical human cadaver study.

Intramedullary cannulated compression screws have been introduced for the fixation of unstable metacarpal fractures. In the present study, this technique was compared with dorsal compression plating to evaluate its biomechanical performance in stabilizing metacarpal shaft fractures. In a first set of experiments, the biomechanical characteristics of the screws were analysed in an artificial bone model. In subsequent experiments, midshaft osteotomies were performed in human cadaver metacarpals, followed by plating or intramedullary screw osteosynthesis. The metacarpals were tested to failure in cantilever bending, following a stepwise increasing cyclic loading protocol. We found a significantly lower load at failure and a significantly lower number of cycles to failure in the intramedullary screw group, but both methods offered sufficient stability under these loads. With reference to published loads on the metacarpals during use of the hand, we conclude that intramedullary osteosynthesis yields sufficient strength and stiffness for early active motion. A difference in its fixation stability is noted compared with plate fixation, which may not be clinically relevant.

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

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.

Management of unstable metacarpal shaft fractures by k-wires versus mini-plate fixation

Objective To compare the clinical and functional outcome of treatment of unstable metacarpal shaft fracture by K-wires versus open reduction and mini-plate fixation prospectively. Place and duration The study was conducted at the Department of Orthopedic, Al-Zahraa Hospital, Faculty of Medicine for Girls, Al Azhar University, for a duration of 1 year from 1st January 2019 to 30th December 2019. Patients and methods A total of 20 patients with unstable metacarpal shaft fracture were divided into two groups. Group A included 10 patients who were fixed by mini-plate and screws. Group B included 10 patients who were fixed by K-wires. Hand function was assessed 3 months postoperatively and when the patients finish physiotherapy by using Quick DASH score. Results Union occurred in all cases. In group A, only one (5%) case reported tendon adherence. In group B, three (15%) cases reported joint stiffness. Conclusion The mini-plate fixation is superior to K-wire fixation in the treatment of unstable metacarpal shaft fractures.

Percutaneous flowering technique of intramedullary k- wire fixation for metacarpal shaft fractures- Bouquet/ Foucher Technique

Introduction: Metacarpal fractures are one of the most common orthopedic injuries seen in orthopaedic practice. The aim was to study the technique and functional outcome of metacarpal shaft fracture treated with percutaneous flowering (Bouquet Technique/Foucher’s technique) intramedullary fixation of precontoured K wires. Materials and Methods: A nonrandomized, uncontrolled prospective study was performed on 38 patients with 47 metacarpal fractures. They were treated by percutaneous enders type flowering technique (Bouquet) with intramedullary precontoured thin K wires. All patient were screened using inclusion and exclusion criteria and followed up prospectively and assessed the Hand radiologically, clinical and functional outcome, Total active movement, Grip strength, VAS score. Results: Male patients had a significantly higher frequency (68.1%) in comparison to female patients (31.9%) Most common ray affected was 4th and 5th ray followed by 2nd ray and then third ray. 38.3% of fractures were oblique type and 53.2% fractures were transverse, spiral and comminuted being 8.5%. Shaft of metacarpal fracture was maximum affected (74.5%) followed by base (14.9%) and neck (10.6%). 50% patients underwent implant removal in a period of 6 weeks. Conclusion: This method is simple, needs minimal instruments like plier, T handle, k wire cutter bender and is cost effective, and well tolerated and with added advantage of early bone healing with good functional outcome. Being percutaneous technique there is no operative incision scar or need of anaesthesia required for removal of k wires after the treatment period. Keywords: Bouquet technique of Precontoured, Intramedullary K wire flowering fixation, Metacarpal fracture.