A New Technique of Locked, Flexible Intramedullary Nailing of Spiral and Comminuted Fractures of the Metacarpals: A Series of 21 Cases

Abstract

Background Spiral and comminuted fractures of the metacarpals are rotationally and axially unstable fractures with a tendency to shorten, which in turn causes significant extensor lag and loss of grip strength. We have designed a new, cheap and locally developed method of locked intramedullary nailing of these metacarpal fractures. We are presenting the results of our first 21 patients with 22 fractures treated by closed, fluoroscopically assisted, intramedullary K-wiring with proximal locking done by a specially designed locking pin. Materials and Methods This was a retrospective, observational cohort study of all patients with spiral and comminuted fractures of metacarpals with minimum of 1 year of follow-up and average follow-up of 14 months (range, 12 to 26 months). The patients were evaluated clinico-radiologically using range of motion, extensor lag, time to healing, amount of collapse, angulation and rotation and complications. Results All fractures had healed uneventfully with average time to union being 8 weeks. Average metacarpal shortening was 2.04±0.95 mm, while the average post-operative angulation of the fracture was 4.81°±1.7. The metacarpophalangeal range-of-motion recovered almost fully with the average extensor lag being only 5.22°±2.42. Other than extensor tendinitis in two patients, there were no other complications.Conclusions This method is cosmetically appealing, provides stable fixation, avoids periosteal stripping associated with open reduction and is associated with very low complication rate, and thus can be safely and effectively used for the treatment of these difficult fractures.

Early Results of Bouquet Technique in Treatment of Metacarpal Fractures

“…A third of all hand fractures are metacarpal fractures, which are fairly common. Most of these fractures can be treated with protective splintage and early motion because they are closed, simple, transverse, or short oblique (3) .…”

Comparative Study between Kirschner Wires and Mini-Set Plate in Management of Unstable Metacarpal Shaft Fractures

“…Cracks of the metacarpals are very normal, adding up to around 33% of all hand breaks. A lion's share of these cracks are shut, basic, transverse, or short slanted and are agreeable to defensive splintage and early movement [10].…”

“…Shortening of the metacarpal by as much as 2 mm prompts an extensor slack of 7° and a 8% hold quality misfortune. Additionally rotational deformation of the metacarpals is ineffectively endured as the pivoted finger will in general get encroached or covered with different fingers [10].…”

“…There have been numerous reports of issues with utilizing plating for these breaks, for example, introduction of the crack site to be specific piece devascularization and delicate tissue disturbance, solidness is likewise a significant issue and these plates cause noteworthy osteopenia. Additionally the relationship of investigation of inner obsession suggests routine evacuation of these plates at around a half year after medical procedure which involves another surgery [10].…”

Outcomes of Threaded Intramedullary Headless Nail Fixation for Metacarpal Fractures

“…This technique was improved by Orbay and Touhami by adding a locking pin to the proximal end of the nail [ 5 ]. Outcomes of this fixation technique compare favorably to K-wire fixation with an average time to union of 6.3-8.0 weeks and a 16-day earlier return to work [ 3 , 4 , 11 , 12 ].…”