Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients

Abstract

Although extra-articular metacarpal fractures are common, there is no consensus on the mode of treatment. We evaluated the outcome in 67 patients operated for isolated, extra-articular fractures in the neck or shaft of the ulnar two metacarpals 28 months post-operatively. There were 22 bouquet (intra-medullary) pinnings and 45 transverse pinnings; 11 were lost to follow-up. Overall, hand function was good, and no difference was detected between the two methods (QuickDASH, grip strength, range of motion, VAS pain and VAS satisfaction). Many patients suffered complications: 12% had a superficial infection (all treated with transverse pinning with wires left exposed); 39% had some impairment in skin sensation; 29% reported cold intolerance; and 10% had other complications. Due to the potential risk of a secondary fracture of the neighbouring metacarpal after transverse pinning, we recommend bouquet (intra-medullary) pinning. We also recommend burying wires beneath the skin surface to avoid infection.

Prevalence of Cold Sensitivity in Patients with Hand Pathology

“…An investigation of patients with fingertip injuries reported 85 % of patients had cold sensitivity and 12 % with severe symptoms [30]. In a study of patients with metacarpal fractures, 30 % of patients reported cold sensitivity [23]. A study which evaluated different types of immobilization following digital nerve repair found that 43 % of patients reported cold sensitivity [9].…”

Biomechanical Evaluation of Metacarpal Fracture Fixation: Application of a 90° Internal Fixation Model

“…This construct is often palpable and may result in extensor tendon irritation and, on occasion, tendon rupture [3,4,23]. Intramedullary techniques have been developed in an attempt to avoid these hardware-related complications; however, this technique is often difficult, is applicable to a limited subset of fractures, and has generally not attained widespread use among hand surgeons [9,17,21].…”

Kirschner Wire Exposure in Hand and Wrist Trauma

“…The 2 small studies that directly compared distinct groups of patients with buried or exposed wires found a higher incidence of pin track infection with the exposed wires. 8,9 The 1 randomized, prospective study similarly is small enough that the findings might be spurious. 10 This study produced the highest overall rate of pin track infection (34%), perhaps linked to the authors' definition as Oppenheim grade 2 or higher (redness and tenderness in soft tissues with or without discharge of pus).…”

“…8 No patients with buried K-wires experienced pin track infections, but 8 patients (18%) with exposed wires sustained pin track infections. The authors recommended burying K-wires to avoid pin track infection.…”