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CC BY-NC 4.0 · Arch Plast Surg 2014; 41(06): 768-772
DOI: 10.5999/aps.2014.41.6.768
Original Article

Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone

Sung Jun Moon
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea
,
Jae-Won Yang
Hand and Micro Plastic Surgery, Gangnam Jaejun Plastic Clinic, Pyeongtaek, Korea
,
Si Young Roh
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea
,
Dong Chul Lee
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea
,
Jin Soo Kim
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea
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Background To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone.

Methods A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire.

Results During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group.

Conclusions Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

Keywords

Metacarpal bones - Fracture fixation - Intramedullary - Fractures, closed


Publication History

Received: 30 April 2014

Accepted: 16 June 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • References

  • 1 Black D, Mann RJ, Constine R. et al. Comparison of internal fixation techniques in metacarpal fractures. J Hand Surg Am 1985; 10: 466-472
    CrossrefPubMedGoogle Scholar
  • 2 Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 2006; 22: 287-295
    CrossrefPubMedGoogle Scholar
  • 3 Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br 2006; 31: 61-65
    PubMedGoogle Scholar
  • 4 Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995; 20: S86-S90
    CrossrefPubMedGoogle Scholar
  • 5 Orbay JL, Touhami A. The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails. Hand Clin 2006; 22: 279-286
    CrossrefPubMedGoogle Scholar
  • 6 Botte MJ, Cohen MS, Lavernia CJ. et al. The dorsal branch of the ulnar nerve: an anatomic study. J Hand Surg Am 1990; 15: 603-607
    CrossrefPubMedGoogle Scholar
  • 7 Itadera E, Hiwatari R, Moriya H. et al. Closed intramedullary fixation for metacarpal fractures using J-shaped nail. Hand Surg 2008; 13: 139-145
    CrossrefPubMedGoogle Scholar
  • 8 Polat O, Comert A, Atalar H. et al. Safe percutaneous pinning for subcapital fifth metacarapl fractures: an anatomical stusy. Acta Ortop Bras 2011; 19: 106-109
    CrossrefGoogle Scholar
  • 9 Rhee SH, Lee SK, Lee SL. et al. Prospective multicenter trial of modified retrograde percutaneous intramedullary Kirschner wire fixation for displaced metacarpal neck and shaft fractures. Plast Reconstr Surg 2012; 129: 694-703
    CrossrefPubMedGoogle Scholar
  • 10 Schadel-Hopfner M, Wild M, Windolf J. et al. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?. Arch Orthop Trauma Surg 2007; 127: 435-440
    CrossrefPubMedGoogle Scholar