Median Nerve Injury following K-wire Fixation of Bennett's Fracture—Lessons Learned

Sidharthan, Sujith; Shetty, Sanath Kumar; Hanna, Amir W.

doi:10.1007/s11552-010-9266-8

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…We did find cases of damage to the superficial radial nerve and median nerve by K-wire transection and migration, respectively. 9,10 Given that K-wire fixation of the thumb is a common procedure, we hypothesize that this is an underreported complication.…”

Section: Discussionmentioning

confidence: 99%

Injury to the Distal Motor Branch of the Ulnar Nerve From Thumb K-Wire Fixation

Heyns

Steve

Hurdle

et al. 2018

Plastic Surgery Case Studies

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We present a complication of trapeziectomy with hematoma distraction arthroplasty for thumb carpometacarpal joint arthritis in a 61-year-old female. Shortly after Kirschner (K)-wire removal at 5.5 weeks post-operatively, the patient noted weakness with thumb adduction. Electromyography and nerve conduction studies done at 3, 5, and 14 months post-operatively showed acute axonal ulnar neuropathy affecting the deep, distal motor branch of the left hand with subsequent partial recovery of function. We postulate that insertion of 1 of the 2 K-wires resulted in a third-degree transection injury to the deep motor branch of the ulnar nerve. To our knowledge, this complication has not been previously reported. We believe it is important for surgeons performing this procedure to be aware of this potential complication as it results in a significant functional disability for the patient.

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Section: Discussionmentioning

confidence: 99%

Injury to the Distal Motor Branch of the Ulnar Nerve From Thumb K-Wire Fixation

Heyns

Steve

Hurdle

et al. 2018

Plastic Surgery Case Studies

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“…Skin drilling pins are commonly used due to their ability to reduce the risk of muscle-tendon adhesion [ 32 , 33 ]. All techniques of osteosynthesis pin fixation through the skin carry a risk of infection or nerve damage [ 34 ], and all techniques that avoid the trapeziometacarpal joint are at risk of joint stiffness, infectious arthritis, or post-traumatic arthritis [ 24 , 35 ]. To avoid these issues, the of use screws instead of pins has been proposed.…”

Section: Reviewmentioning

confidence: 99%

“…The main drawback of internal fixation with a single K-wire is the instability and lack of complete halt to secondary motion. Some believe that the inability to achieve reduction through closed fixation is a limitation of percutaneous screw fixation [ 34 ]. Pin fixation without surgical incisions near the fractured bone can be used to reduce the size [ 35 ].…”

Section: Reviewmentioning

confidence: 99%

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture

Malisorn

2024

Cureus

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Repetitive instances of sudden injuries to the first metacarpal bone can affect thumb movement. These injuries typically occur after vertical impact to the thumb. The treatment for these injuries should focus on restoring the structure and biomechanics of the trapeziometacarpal joint, with surgery being recommended for optimal results. Bennett's fracture involves the bifurcation of the bone into two distinct fragments, characterized by a smaller fragment and a larger counterpart. Rolando fracture is associated with a fracture of the base of the first metacarpal bone, typically divided into three parts. An extra-articular fracture involves the metacarpal bone of the thumb. Conservative treatment outcomes have been found to be unsatisfactory when the fracture is displaced. Therefore, surgery methods such as minimally invasive surgery, open reduction, and arthroscopic surgery have been proven to be effective. Surgical techniques for bone procedures include pin fixation, direct screw fixation, indirect screw fixation, and mini-plate fixation. Additionally, the prognosis of this condition depends on the ability to restore joint mobility during rehabilitation.

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“…Some use percutaneous screws (Meyer et al, 2003). All the percutaneous osteosynthesis techniques are at risk of sepsis or nerve injury (Sidharthan et al, 2010) and all those which cross the trapeziometacarpal joint are at risk of joint stiffness, septic arthritis or post-traumatic arthrosis (Capo et al, 2009; Sawaizumi et al, 2005).…”

Section: Treatmentmentioning

confidence: 99%

Fractures and dislocation of the base of the thumb metacarpal

Liverneaux

Ichihara

Hendriks

et al. 2014

J Hand Surg Eur Vol

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Acute traumatic lesions of the base of the first metacarpal are frequent and their consequences can affect the opposition of the thumb. They usually occur after trauma in compression along the axis of the thumb in flexion. Restoring the anatomy and biomechanics of the trapeziometacarpal joint is essential when treating these injuries, hence why surgical treatment is usually indicated. We distinguish trapeziometacarpal dislocations, small-fragment and large-fragment Bennett's fractures, articular three-fragment Rolando and comminutive fractures and extra-articular fractures of the base of the first metacarpal. All carry the risk of narrowing of the first web. Recent studies have described poor results with conservative treatment. Surgical techniques are varied: percutaneous surgery, open surgery and arthroscopic surgery. The techniques of osteosynthesis are various: locking plates, and direct or indirect screw fixation or pinning. The prognosis depends on the quality of the restoration of the mobility of the trapeziometacarpal joint.

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Median Nerve Injury following K-wire Fixation of Bennett's Fracture—Lessons Learned

Cited by 7 publications

References 10 publications

Injury to the Distal Motor Branch of the Ulnar Nerve From Thumb K-Wire Fixation

Injury to the Distal Motor Branch of the Ulnar Nerve From Thumb K-Wire Fixation

The Current Concept and Evidence-Based Practice in the Base of the First Metacarpal Bone Fracture

Fractures and dislocation of the base of the thumb metacarpal

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