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.
Kelsch
Georg
G
Department of Orthopedics and SCI, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. georg@kelsch.de
Ulrich
Christoph
C
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