J Korean Orthop Assoc.  2007 Oct;42(5):608-615. 10.4055/jkoa.2007.42.5.608.

Treatment of Metacarpal Fractures using Transverse Kirschner-wire Fixation

• Choi NY
• Song HS

• KMID: 2186467
• DOI: http://doi.org/10.4055/jkoa.2007.42.5.608

Abstract

PURPOSE: To analyze the clinical results of transverse Kirschner (K)-wire fixation for metacarpal fractures.
MATERIALS AND METHODS
Between May 2002 and May 2005, thirty-four cases (thirty-nine fingers) of unstable metacarpal fractures underwent a closed reduction and transverse K-wire fixation. The neck, shaft and base fractures of the metacarpals except the thumb were included. The follow-up period ranged from 12 months to 3 years and 4 months (mean; 2 years and 1 month). Interfragmentary fixation was performed on 24 cases. A short arm splint was maintained until postoperative 4 weeks, after which the full range of motion was permitted. The K-wires were removed after achieving the full-range of motion or pin-site infection.
RESULTS
At the last follow-up, there was no limitation of motion and discomfort during the daily living activities. Five cases had skin problems around the tip of the K-wire. All cases, except for three cases with angulation over 20 degrees, had achieved the union under five degrees (average 3.24 degrees dorsal angulation). Three cases had minimal rotational deformities but they did not complain of discomfort. The one case of nonunion, in whom the K-wires had been removed four weeks after surgery, underwent plate fixation and a bone graft.
CONCLUSION
Transverse K-wire fixation and additional interfragmentary fixation of the metacarpal fractures can allow the full range of motion without the need to remove the K-wires. The clinical results were excellent.

Keyword

Metacarpal fractures; Transverse fixation; Interfragmentary fixation; Kirschner-wire

MeSH Terms

Activities of Daily Living
Arm
Congenital Abnormalities
Follow-Up Studies
Metacarpal Bones
Neck
Range of Motion, Articular
Skin
Splints
Thumb
Transplants

Figure

• 

  Fig. 1 Plain x-rays of the left hand (M/45) show a long oblique fracture of the 4th metacarpal fixed with a percutaneous mini-screw and 4 transverse K-wires (A, initial AP view; B, initial oblique view; C, postoperative AP view; D, postoperative 2 months oblique view).

• 

  Fig. 2 Plain x-rays of the left hand (M/32) show a long oblique fracture of the 2nd metacarpal fixed with interfragmentary K-wire and 3 transverse K-wires (A, initial AP view; B, initial lateral view; C, postoperative AP view; D, postoperative 4 months AP view).

• 

  Fig. 3 Plain x-rays of the left hand (F/30) show a short oblique fracture of the 3rd metacarpal and a migrated K-wire on the follow-up (A, initial oblique view; B, post-accident 2 weeks oblique view; C, postoperative AP view; D, postoperative 3 months AP view).

• 

  Fig. 4 Plain x-rays of right hand (M/17) show nonunion of the fracture of the 4th metacarpal (A, initial oblique view; B, postoperative AP view; C, postoperative oblique view; D, postoperative 8 weeks oblique view; E, 2nd postoperative 2 months oblique view; F, 2nd postoperative 2 months lateral view).

Reference

1. Berkman EF, Miles GH. Internal fixation of metacarpal fractures exclusive of the thumb. J Bone Joint Surg. 1943. 25:816–821.

2. Black D, Mann RJ, Constine R, Daniels AU. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am. 1985. 10:466–472.

3. Choi SJ, Lee YH, Chang HG, Lee CJ, Cho WH. The 5th metacarpal neck fracture treated by closed reduction and percutaneous intramedullary K-wire fixation. J Korean Fracture Soc. 1995. 8:696–704.

4. Choi SJ, Chang SK. Treatment method of the metacarpal bone fractures with retrograde percutaneous intramedullary K-wire fixation to decrease the injury of extensor tendon. J Korean Soc Surg Hand. 2004. 9:117–122.

5. Fambrough RA, Green DP. Tendon rupture as a complication of screw fixation in fractures in the hand. A case report. J Bone Joint Surg Am. 1979. 61:781–782.

6. Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br. 1999. 24:76–79.

7. Firoozbakhsh KK, Moneim MS, Howey T, Castaneda E, Pirela-Cruz MA. Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques. J Hand Surg Am. 1993. 18:1059–1068.

8. Firoozbakhsh KK, Moneim MS, Doherty W, Naraghi FF. Internal fixation of oblique metacarpal fractures. A biomechanical evaluation by impact loading. Clin Orthop Relat Res. 1996. 325:296–301.

9. Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995. 20:S86–S90.

10. Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma. 2003. 55:509–513.

11. Gould WL, Belsole RJ, Skelton WH Jr. Tension-band stabilization of transverse fractures: an experimental analysis. Plast Reconstr Surg. 1984. 73:111–116.

12. Greene TL, Noellert RC, Belsole RJ, Simpson LA. Composite wiring of metacarpal and phalangeal fractures. J Hand Surg Am. 1989. 14:665–669.

13. Hochwald NL, Levine R, Tornetta P 3rd. The risks of Kirschner wire placement in the distal radius: a comparison of techniques. J Hand Surg Am. 1997. 22:580–584.

14. Jeong CH, Kim HM, Lee KH, Choi MG, Kim YS, Lee DR. Percutaneous intramedullary fixation using prebent K-wires of metacarpal shaft fractures. J Korean Soc Surg Hand. 1999. 4:199–203.

15. Klein DM, Belsole RJ. Percutaneous treatment of carpal, metacarpal, and phalangeal injuries. Clin Orthop Relat Res. 2000. 375:116–125.

16. Lamb DW, Abernethy PA, Raine PA. Unstable fractures of the metacarpals. A method of treatment by transverse wire fixation to intact metacarpals. Hand. 1973. 5:43–48.

17. Lister G. Intraosseous wiring of the digital skeleton. J Hand Surg Am. 1978. 3:427–435.

18. Matloub HS, Jensen PL, Sanger JR, Grunert BK, Yousif NJ. Spiral fracture fixation techniques. A biomechanical study. J Hand Surg Br. 1993. 18:515–519.

19. Paul AS, Kurdy N, Kay PR. Fixation of closed metacarpal shaft fractures. Transverse K-wires in 22 cases. Acta Orthop Scand. 1994. 65:427–429.

20. Stern PJ, Wieser MJ, Reilly DG. Complications of plate fixation in the hand skeleton. Clin Orthop Relat Res. 1987. 214:59–65.