title: Percutaneous elastic intramedullary nailing of metacarpal fractures: surgical technique and clinical results study.
abstract: BACKGROUND
  We reviewed our results and complications of using a pre-bent 1.6 mm Kirschner wire (K-wire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity.
  
  
  METHODS
  A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimeters and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5 mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic.
  
  
  RESULTS
  We studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days). All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks). At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment.
  
  
  CONCLUSIONS
  With this simple and minimally invasive technique performed as day-case surgery, all patients were able to start mobilisation immediately. The general outcome was good hand function with few complications.
authors.affiliation: Trauma & Orthopaedics, Hywel Dda NHS Trust, Carmarthen, SA31 2AF, UK. riaz22@hotmail.co.uk
authors.forename: Riazuddin
authors.initials: R
authors.lastname: Mohammed
authors.forename: Mohamed Z
authors.initials: MZ
authors.lastname: Farook
authors.forename: Kevin
authors.initials: K
authors.lastname: Newman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001858:Bone Nails; D001864:Bone Wires; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries*; D011859:Radiography; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents