Arch Hand Microsurg.  2021 Dec;26(4):231-237. 10.12790/ahm.21.0127.

Comparison of Results Based on the Number of Kirschner Wires of Different Diameters in Antegrade Intramedullary Fixation of Fifth Metacarpal Neck Fractures

• Lee DC
• Park JH
• Koh SH
• Kim JS
• Lee KJ
• Roh SY

• KMID: 2522620
• DOI: http://doi.org/10.12790/ahm.21.0127

Abstract

Purpose
The purpose of this study was to compare the clinical and radiological results of patients with fifth metacarpal neck fractures using different sizes and numbers of Kirschner wires (K-wire).
Methods
A single institutional retrospective review identified 67 patients with a fifth metacarpal neck fracture between January 2015 and July 2020. The minimum follow-up time was 6 months and they were all treated within 6.4 days of the initial injury. Either one K-wire (1.6 mm), two K-wires (1.1 mm), or three K-wires (0.9 mm) was used. We analyzed the bone union period, and K-wire removal period, duration of surgery, total active motion, intramedullary diameter, pre/postoperative shortening, and pre/postoperative angulation clinically. We used a Method of Shortening Stipulated to measure shortening and the Medullary Canal-lateral view method for angulation. The intramedullary diameter was measured in the mid-shaft of the fifth metacarpal bone in the coronal view. Total active motion was measured at the time of follow-up in our outpatient department.
Results
Clinical and radiological parameters showed no statistically significant differences. Even though it did not present a statistical significance, the absolute mean duration of surgery was the shortest in a single K-wire group.
Conclusion
The clinical and radiological outcomes of surgery were comparable regardless of the number of K-wires inserted. However, we could look forward to gaining potential benefit from shortened operation time in a single K-wire group. Since stable fixation can be obtained even if one K-wire is used, inserting one thick K-wire into the intramedullary canal can be an alternative according to the surgeon’s preference.

Keyword

Metacarpal bones; Neck; Fracture; Bone wires

Figure

• 

  Fig. 1. (A) The hole was drilled using an awl, taking care not to perforate the cortical bone on the opposite side. (B) A pre-bent Kirschner wire (K-wire) with smooth distal ends is inserted distally into the metacarpal through the hole. The tip of the K-wire is advanced to the metacarpal head.

• 

  Fig. 2. These are each case of using one, two, and three Kirschner wires for the intramedullary fixation of the fifth metacarpal neck fracture.

• 

  Fig. 3. (A) Measurement using a Method of Shortening Stipulated at the anteroposterior view. A red line was drawn through the most distal point of the heads of the neighboring third and fourth metacarpals. The shortening was defined as the distance from this line to the most distal point of the fractured fifth metacarpals (white). (B) Measurement using Medullary Canal-lateral view method at the lateral view. The distal line (red) was drawn from the mid-medullary point in the center of the neck fracture to the most distal point of the meatcarpal head, and the proximal line (yellow) centrally through the shaft medullary canal.

Reference

1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001; 26:908–15.

2. Sadiq M, Hussain SA. Management of boxers fracture with single antegrade bent K-wire. Int J Res Orthop. 2019; 5:398–402.

3. Gonzalez MH, Hall RF Jr. Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand. Clin Orthop Relat Res. 1996; (327):47–54.

4. Corkum JP, Davison PG, Lalonde DH. Systematic review of the best evidence in intramedullary fixation for metacarpal fractures. Hand (N Y). 2013; 8:253–60.

5. Foucher G. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995; 20(3 Pt 2):S86–90.

6. Dijkman BG, Sprague S, Schemitsch EH, Bhandari M. When is a fracture healed?: radiographic and clinical criteria revisited. J Orthop Trauma. 2010; 24 Suppl 1:S76–80.

7. Sletten IN, Nordsletten L, Hjorthaug GA, Hellund JC, Holme I, Kvernmo HD. Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur Vol. 2013; 38:658–66.

8. Assi C, Mansour J, Samaha C, Ajjoub S, Yammine K. A single antegrade intramedullary k-wire for fifth metacarpal neck fractures. Eur J Trauma Emerg Surg. 2020; 46:389–95.

9. Kelsch G, Ulrich C. Intramedullary k-wire fixation of metacarpal fractures. Arch Orthop Trauma Surg. 2004; 124:523–6.

10. Kaynak G, Botanlioglu H, Caliskan M, Karaismailoglu B, Ozsahin MK, Kocak S, et al. Comparison of functional metacarpal splint and ulnar gutter splint in the treatment of fifth metacarpal neck fractures: a prospective comparative study. BMC Musculoskelet Disord. 2019; 20:169.

11. Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am. 1999; 24:835–44.

12. Strub B, Schindele S, Sonderegger J, Sproedt J, von Campe A, Gruenert JG. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck?: a prospective study. J Hand Surg Eur Vol. 2010; 35:725–9.

13. Moon SJ, Yang JW, Roh SY, Lee DC, Kim JS. Comparison between intramedullary nailing and percutaneous K-wire fixation for fractures in the distal third of the metacarpal bone. Arch Plast Surg. 2014; 41:768–72.

14. Biz C, Iacobellis C. Comparison of percutaneous intramedullary Kirschner wire and interfragmentary screw fixation of displaced extra-articular metacarpal fractures. Acta Biomed. 2014; 85:252–64.

15. Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015; 473:1747–54.

16. Downing ND, Davis TR. Intramedullary fixation of unstable metacarpal fractures. Hand Clin. 2006; 22:269–77.

17. Liew KH, Chan BK, Low CO. Metacarpal and proximal phalangeal fractures: fixation with multiple intramedullary Kirschner wires. Hand Surg. 2000; 5:125–30.