Treatment of Closed Unstable Metacarpal Fractures Using Percutaneous Transverse Fixation with Kirschner Wires

Abstract

Treatment of closed metacarpal neck, shaft, and intra-articular fractures of the base of the fifth metacarpal with percutaneous transverse pinning, using two K-wires distally and one proximally, has shown excellent functional and anatomic outcome.

Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning

“…To the best of our knowledge, several papers have been published on the transverse K-wire fixation technique for treatment of fractures of the metacarpals, 6,7,16,17 but no mediumor long-term results have been reported. In their short-term retrospective study with only 3 months of follow-up, Galanakis et al 6 reported excellent functional and radiographic outcomes in a series of patients affected by unstable metacarpal fractures treated with percutaneous transverse fixation with K-wires.…”

“…In fact, malrotation or volar angulation of the metacarpal head may frequently cause reduction in the grip strength and lack of full extension of the fifth finger. [3][4][5][6][7] The results of surgical treatment seem to be influenced by the preoperative condition of the soft tissues of the hand; therefore, in fractures associated with softtissue injuries, most authors suggest minimising the surgical trauma so as to obtain better results. 3,6 Berkman and Miles 8 first described transverse wire fixation to intact metacarpals for treatment of unstable fractures of the metacarpal bones.…”

“…[3][4][5][6][7] The results of surgical treatment seem to be influenced by the preoperative condition of the soft tissues of the hand; therefore, in fractures associated with softtissue injuries, most authors suggest minimising the surgical trauma so as to obtain better results. 3,6 Berkman and Miles 8 first described transverse wire fixation to intact metacarpals for treatment of unstable fractures of the metacarpal bones. The purpose of this retrospective study was to report the medium-term results in 28 patients affected by displaced fracture of the neck of the fifth metacarpal (boxer's fracture), with an associated severe swelling of the surrounding soft tissues, who were treated by percutaneous transverse pinning.…”

“…3,6 Berkman and Miles 8 first described transverse wire fixation to intact metacarpals for treatment of unstable fractures of the metacarpal bones. The purpose of this retrospective study was to report the medium-term results in 28 patients affected by displaced fracture of the neck of the fifth metacarpal (boxer's fracture), with an associated severe swelling of the surrounding soft tissues, who were treated by percutaneous transverse pinning.…”

Colocação segura de pinos percutâneos em fraturas subcapitais do quinto metacarpo: um estudo anatômico

“…7,8 Researchers affirmed that the treatment of closed fractures of the metacarpal neck, diaphyseal fractures and intraarticular fifth metacarpal base fractures with transversal percutaneous pinning, using two K-wires distally and one proximally, demonstrated excellent functional and anatomical outcome. 9 The dorsal branch of ulnar nerve (DBUN) emerges proximally to the wrist, passes distally and dorsally deep to the extensor carpi ulnaris muscle, perforates the fascia profundis and descends along the medial side of the wrist and of the hand to split in two or, frequently, three dorsal digital nerves that innervate the ulnar side of the ring finger and both sides of the little finger. One innervates the medial (ulnar) side of the little finger, the second, the adjacent sides of the little and ring fingers, while the third, when present, innervates the contiguous sides of the ring and middle fingers; nevertheless, it can be totally or partially substituted by a radial nerve branch, always communicating with it on the back of the hand.…”