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CC BY-NC 4.0 · Arch Plast Surg 2016; 43(02): 189-196
DOI: 10.5999/aps.2016.43.2.189
Original Article

The Efficacy of Transverse Fixation and Early Exercise in the Treatment of Fourth Metacarpal Bone Fractures

Suk-Ho Moon
Department of Plastic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Hak-Soo Kim
Department of Plastic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Sung-No Jung
Department of Plastic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Ho Kwon
Department of Plastic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Background Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture.

Methods A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated.

Results Dorsal angulation improved from a preoperative value of 44.2° to a postoperative value of 5.9°. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed.

Conclusions We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization.

Keywords

Metacarpal bones - Bone wire - Fracture fixation

This article was presented as a poster at the International Congress of the Korean Society of Plastic and Reconstructive Surgeons on October, 2014 in Seoul, Korea.




Publication History

Received: 18 June 2015

Accepted: 30 July 2015

Article published online:
20 April 2022

© 2016. 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 Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993; 27: 317-319
    CrossrefPubMedGoogle Scholar
  • 2 Lambotte A. Contribution a la chirurgie conservatrice de la main doms les traumatismes. Arch Franco Belges Chir 1928; 31: 759-761
    Google Scholar
  • 3 Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995; 20: S86-S90
    CrossrefPubMedGoogle Scholar
  • 4 Gonzalez MH, Igram CM, Hall Jr RF. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am 1995; 20: 382-387
    CrossrefPubMedGoogle Scholar
  • 5 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
  • 6 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
  • 7 Winter M, Balaguer T, Bessiere C. et al. Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur Vol 2007; 32: 709-713
    CrossrefPubMedGoogle Scholar
  • 8 Westbrook AP, Davis TR, Armstrong D. et al. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol 2008; 33: 732-739
    CrossrefPubMedGoogle Scholar
  • 9 Galanakis I, Aligizakis A, Katonis P. et al. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma 2003; 55: 509-513
    CrossrefPubMedGoogle Scholar
  • 10 Ceim U. Small fragment set manual. In: Heim U, Pfeiffer KM, Oberli K. Internal fixation of small fractures: technique recommended by the AO-ASIF Group. 3rd ed. New York: Springer-Verlag; 1982: 480-484
    Google Scholar
  • 11 Cooney III WP, Smith DK. External fixation of the upper extremity. In: American Academy of Orthopaedic Surgeons. AAOS Instructional Course Lectures. St. Louis: CV Mosby; 1987: 445-469
    Google Scholar
  • 12 Riggs Jr SA, Cooney 3rd WP. External fixation of complex hand and wrist fractures. J Trauma 1983; 23: 332-336
    CrossrefPubMedGoogle Scholar
  • 13 Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br 1999; 24: 76-79
    CrossrefPubMedGoogle Scholar
  • 14 Paul AS, Kurdy N, Kay PR. Fixation of closed metacarpal shaft fractures: transverse K-wires in 22 cases. Acta Orthop Scand 1994; 65: 427-429
    CrossrefPubMedGoogle Scholar
  • 15 Gropper PT, Bowen V. Cerclage wiring of metacarpal fractures. Clin Orthop Relat Res 1984; (188) 203-207
    PubMedGoogle Scholar
  • 16 Lister G. Intraosseous wiring of the digital skeleton. J Hand Surg Am 1978; 3: 427-435
    CrossrefPubMedGoogle Scholar
  • 17 Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res 2006; 445: 133-145
    CrossrefPubMedGoogle Scholar
  • 18 Sohn RC, Jahng KH, Curtiss SB. et al. Comparison of metacarpal plating methods. J Hand Surg Am 2008; 33: 316-321
    CrossrefPubMedGoogle Scholar
  • 19 Waris E, Ashammakhi N, Raatikainen T. et al. Self-reinforced bioabsorbable versus metallic fixation systems for metacarpal and phalangeal fractures: a biomechanical study. J Hand Surg Am 2002; 27: 902-909
    CrossrefPubMedGoogle Scholar
  • 20 Han SH, Rhee SY, Lee SC. et al. Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger. Eur J Orthop Surg Traumatol 2013; 23: 883-887
    CrossrefPubMedGoogle Scholar
  • 21 Lee SK, Kim KJ, Choy WS. Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures. Eur J Orthop Surg Traumatol 2013; 23: 535-543
    CrossrefPubMedGoogle Scholar
  • 22 Hong SJ, Lee HJ, Kim JY. et al. K-wire breakage during metalware removal due to a defective K-wire shaft. Arch Plast Surg 2013; 40: 655-657
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Sletten IN, Nordsletten L, Husby T. et al. 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. J Hand Surg Eur Vol 2012; 37: 387-395
    CrossrefPubMedGoogle Scholar
  • 24 Soni A, Gulati A, Bassi JL. et al. Outcome of closed ipsilateral metacarpal fractures treated with mini fragment plates and screws: a prospective study. J Orthop Traumatol 2012; 13: 29-33
    CrossrefPubMedGoogle Scholar
  • 25 Macey AC, Burke FD, Abbott K. et al. Outcomes of hand surgery: British Society for Surgery of the Hand. J Hand Surg Br 1995; 20: 841-855
    PubMedGoogle Scholar