Intramedullary k-wire fixation of metacarpal fractures.
BACKGROUND
The majority of metacarpal fractures can be treated conservatively. Nevertheless, surgical treatment is justified in certain cases. Palmar dislocation of >30 degrees and shortening of >5 mm will significantly affect extension and flexion of the hand. Consequently, surgical treatment is indicated. The aim of our study was to evaluate the clinical results of intramedullary Kirschner-wire fixation of metacarpal fractures.


METHODS
In a retrospective study we analyzed the clinical results of 35 patients with metacarpal fractures that had been treated by closed reduction and elastic fixation with at least two intramedullary k-wires.


RESULTS
Most of the patients were young, with good bone quality and low anesthetic risk, and they had suffered the fractures as a result of a direct trauma. Predominantly uncomplicated, the fractures were metaphyseal, subcapital and of the fifth metacarpal bone (750.3-B1 fractures). Surgical treatment was indicated for a palmar axis dislocation of >20 degrees or if a rotatory deficiency was present. Metacarpal joint function and correction of rotatory displacement could be assessed on median after a period of 1.1 year. In 34 patients flexion and extension was normal on both sides. In one patient we found an extension deficiency of 15 degrees and a rotatory deficiency of 10 degrees . In 34 out 35 patients with metacarpal fractures, minimally invasive intramedullary k-wire osteosynthesis resulted in complete restoration.


CONCLUSIONS
Intramedullary k-wire fixation is a minimally invasive method for stabilizing metacarpal fractures. The excellent long-term clinical results are due to the fact that the gliding tissue around the fracture will not be affected at all by the surgical procedure.
Department of Orthopedics and SCI, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. georg@kelsch.de
Georg
G
Kelsch
Christoph
C
Ulrich
D000293:Adolescent; D000328:Adult; D000368:Aged; D001864:Bone Wires; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008663:Metacarpus / Q000293:injuries*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome