Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review

Abstract

PurposeOpen reduction and internal fixation (ORIF) of single, closed metacarpal shaft fractures is increasingly preferred over closed reduction and percutaneous fixation (K-wire). The aim of this systematic review is to determine whether the preference for ORIF can be substantiated based on the available literature regarding the functional outcome and complications after surgery.MethodsA systematic review was performed using a computer-based search on MedLine and Embase, following the preferred reporting items for systematic and meta-analyses guidelines.ResultsFive non-comparative studies were found. Two studies reported on 36 ORIF-treated patients. Three studies reported on 65 K-wire-treated patients. Complications were reported in 8 ORIF-treated patients (22 %) and in 23 K-wire-treated patients (35 %). Functional outcome was generally reported as good for both techniques. Nonetheless functional impairment requiring reoperation was reported in 6 ORIF-treated patients (17 %) and in none of the K-wire-treated patients.ConclusionsAlthough for both techniques good functional outcomes were reported, the significance of the functional impairment after ORIF requiring reoperation suggests ORIF to be a less favorable technique for single, closed metacarpal shaft fractures.

Extra-articular Metacarpal Fractures: Closed Reduction and Percutaneous Pinning Versus Open Reduction and Internal Fixation

“…This finding is consistent with the literature demonstrating better outcomes with pinning versus plating of fifth metacarpal neck fractures specifically. 2,11 Fractures treated with percutaneous pinning were immobilized an average of nearly 2 weeks longer than those treated with plate or screw fixation. However, in this series, prolonged immobilization did not contribute to changes in ultimate TAM, stiffness, need for therapy, or need for revision surgery.…”

Antegrade intramedullary Kirschner-wire fixation of displaced metacarpal shaft fractures

“…The incidence of our complications appears to be lower compared to other frequently used techniques such as plate fixation and transverse pinning [3,5,8]. Bone-healing disorders after surgical treatment of metacarpal shaft fractures in general are rare.…”

“…Functional limitations are more frequently encountered, probably due to postoperative adhesions or scar tissue. The recently published systematic review of Greeven et al provides a clear overview of the literature and complication rates of both transverse pinning and plate fixation of metacarpal shaft fractures [3]. Just like intramedullary fixation, transverse pinning is characterized by minimal softtissue injury, but shows a high incidence of (pin tract) infections up to 25%.…”

“…When surgical intervention is considered, multiple techniques are advocated in the literature such as transverse pinning, minifragment lag screws, and plate fixation [3,4]. Although multiple studies have shown that plate fixation leads to a very rigid fixation, this technique requires significant soft-tissue dissection.…”

Three-screw versus two-screw fixation of distal fragment in fifth metacarpal neck fractures stabilized with locking plate

“…We therefore showed that locking plate in combination with two crossed K-wires could decrease the secondary displacement in volar angulation compared with fixation with locking plate alone in previous study 11 . However, percutaneous K-wire fixation could also lead to an increase in surficial infection and irrigation of skin 12 . In addition, pin tract infection was also a major complication after K-wire fixation 13 .…”