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

Abstract

BackgroundTo 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.MethodsA 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.ResultsDuring 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.ConclusionsIntramedullary 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.

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

“…In line with aforementioned previous studies (27,37), the operating time in the present study was relatively short. The ROM of the MCP joint recovered well postoperatively and the average DASH score was 1.7, demonstrating that the function of the affected side underwent good recovery (DASH scores are on a scale from 0-100, with higher scores indicating greater disability).…”

Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures

“…20 Moon et al examined the clinical outcomes from trans K-wire pinning versus IMN in 41 patients with a distal third metacarpal fracture. 11 In their study, in which 19 and 22 patients were assigned to either IMN or K-wire fixation, respectively, operation time was 14 minutes shorter in the K-wire group, yet the IMN group averaged a 2.3 week earlier return to work. Three of the 22 patients in the K-wire group had associated superficial wound infections, whereas none occurred in the IMN group.…”

“…7 Previous studies have established no significant difference in radiographic healing time or clinical outcomes of patients treated with IMN fixation, PS fixation, or K-wire pinning. 4,11 Flexible IMNs provide stable fixation of metacarpal fractures with minimal soft tissue dissection, which allows for early mobilization of the wrist and fingers with limited and removable external immobilizations. This is supported by the results of this study, as patients regained 72.4% wrist ROM 2 weeks postoperatively and full ROM at final follow-up.…”

“…7 Previous studies have established no significant difference in radiographic healing time or clinical outcomes of patients treated with IMN fixation, PS fixation, or K-wire pinning. 4,11…”

Comparison of Results Based on the Number of Kirschner Wires of Different Diameters in Antegrade Intramedullary Fixation of Fifth Metacarpal Neck Fractures

“…Clinical and radiographic results according to the number of Kirschner wires (K-wires)13.38° (3개)로 교정되었음을 확인하였으나 통계적으로 K강선 개 수에 따른 차이는 없었다(SH-Stip, p = 0.935; MC-90, p = 0.914). 가골교가 생성되고 골절 선이 소실되기까지의 골 유합 기간은 2개의 K강선을 사용한 그룹(6.4주)에서 1개(7.24주), 3개 고정술은 몇 가지 합병증을 야기하기도 한다.…”