A Single Intramedullary K-Wire Is Sufficient for the Management of Nonthumb Metacarpal Shaft Fractures

Abstract

Objective. This study aims to evaluate the outcome after the internal fixation of diaphyseal metacarpal fractures by a single intramedullary K-wire. Methods. In this prospective case series study, conducted from July 2017 to June 2019 in 23 adult patients with a single, unstable, diaphyseal metacarpal fracture, outcomes after internal surgical fixation using a single antegrade intramedullary K-wire were evaluated. The outcomes were evaluated by union rate, time to union, handgrip measurements at 6 and 12 months, and the modified Disabilities of the Arm, Shoulder, and Hand (DASH) score at 12 months. Results. The study population consisted of 17 males and 6 females, with a mean patient age of 28.4 ± 8.5 years (range, 16–45 years). The median time to final follow-up was 14 ± 1.8 months (range: 12–24 months). The mean duration of the union was 7.3 ± 1.6 weeks (range: 5–11 weeks), with a union rate of 95.7% (22 cases). The mean handgrip strength was 68% ± 12.8% of the strength of the uninjured hand after 6 months and 92.7% ± 6.9% after 12 months. The mean modified DASH score was 2.6 ± 0.26 after 12 months (range: 0–5.8). There were no cases of malrotation or infection. In conclusion, using a single 1.8–2.0 mm K-wire gives excellent functional outcomes and union rate without significant complications when used to treat an unstable metacarpal shaft fracture.

Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization

“…There are many described techniques and postoperative protocols for this procedure. Abulsoud et al were the first to report a study that describes and investigates the outcomes of fixation of metacarpal shaft fractures using a single, 1.8–2.0 mm, buried K-wire [ 18 ]. In our technique, due to a smaller body configuration of the Asian population, it is difficult to insert a 1.8 mm K-wire into the metacarpal medullary canal.…”

“…From our findings and previous reported literature, immediate gentle postoperative ROM of the metacarpophalangeal joint (MPJ) and interphalangeal joint (IPJ) does not affect fracture healing or patient's hand function [ 28 ]. Immediate mobilization provides several advantages, including a rapid return to daily activities, fast recovery of hand ROM, and fewer complications and discomfort from prolonged immobilization [ 18 , 23 , 24 , 27 , 28 , 30 ]. Our operative technique and protocol of immediate mobilization are slightly different from what was described earlier by Rocchi et al [ 28 ].…”

“…No malrotation was seen in the metacarpal fracture with no initial rotatory displacement even after early mobilization of the DTML was intact [ 31 ]. Rotatory displacement after the flexible fixation of metacarpal fracture is rare [ 7 , 18 , 19 , 21 , 23 , 24 , 26 , 40 , 44 , 45 ]. Though we are unable to measure an exact malrotation of the metacarpal in our population, finger scissoring had never been noticed.…”

“…Complications of single IM K-wire fixation in metacarpal shaft fractures include stiffness, nonunion, and metacarpal head perforation [ 18 ]. Though we did not observe these complications in our population, we did notice other complications.…”

“…The study was conducted between January 2019 and December 2022. The inclusion criteria were as follows: (1) closed simple transverse or short oblique metacarpal shaft fractures and (2) unacceptable deformities [ 13 , 18 ] that could not be treated by nonoperative treatment or patients who could not withstand conservative treatment with a slab or cast immobilization. We included patients with either single or multiple metacarpal shaft fractures.…”