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

  • Moon, Suk-Ho (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hak-Soo (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Jung, Sung-No (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Ho (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea)
  • Received : 2015.06.18
  • Accepted : 2015.07.30
  • Published : 2016.03.18

Abstract

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 $44.2^{\circ}$ to a postoperative value of $5.9^{\circ}$. 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

References

  1. Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993;27: 317-9. https://doi.org/10.1080/02844311.1993.12005647
  2. Lambotte A. Contribution a la chirurgie conservatrice de la main doms les traumatismes. Arch Franco Belges Chir 1928; 31:759-61.
  3. Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995;20: S86-90. https://doi.org/10.1016/S0363-5023(95)80176-6
  4. Gonzalez MH, Igram CM, Hall RF Jr. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am 1995; 20:382-7. https://doi.org/10.1016/S0363-5023(05)80091-7
  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;31:61-5.
  6. Orbay JL, Touhami A. The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails. Hand Clin 2006;22:279-86. https://doi.org/10.1016/j.hcl.2006.02.017
  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;32:709-13. https://doi.org/10.1016/j.jhse.2007.07.011
  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: 732-9. https://doi.org/10.1177/1753193408092497
  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;55:509-13. https://doi.org/10.1097/01.TA.0000029368.40479.A2
  10. Ceim U. Small fragment set manual. In: Heim U, Pfeiffer KM, Oberli K, et al., editors. Internal fixation of small fractures: technique recommended by the AO-ASIF Group. 3rd ed. New York: Springer-Verlag; 1982. p.480-4.
  11. Cooney WP III, Smith DK. External fixation of the upper extremity. In: American Academy of Orthopaedic Surgeons, editor. AAOS Instructional Course Lectures. St. Louis: CV Mosby; 1987. p.445-69.
  12. Riggs SA Jr, Cooney WP 3rd. External fixation of complex hand and wrist fractures. J Trauma 1983;23:332-6. https://doi.org/10.1097/00005373-198304000-00011
  13. Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br 1999;24:76-9. https://doi.org/10.1016/S0266-7681(99)90039-6
  14. Paul AS, Kurdy N, Kay PR. Fixation of closed metacarpal shaft fractures: transverse K-wires in 22 cases. Acta Orthop Scand 1994;65:427-9. https://doi.org/10.3109/17453679408995485
  15. Gropper PT, Bowen V. Cerclage wiring of metacarpal fractures. Clin Orthop Relat Res 1984;(188):203-7.
  16. Lister G. Intraosseous wiring of the digital skeleton. J Hand Surg Am 1978;3:427-35. https://doi.org/10.1016/S0363-5023(78)80135-X
  17. Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res 2006; 445:133-45.
  18. Sohn RC, Jahng KH, Curtiss SB, et al. Comparison of metacarpal plating methods. J Hand Surg Am 2008;33:316-21. https://doi.org/10.1016/j.jhsa.2007.11.001
  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;27:902-9. https://doi.org/10.1053/jhsu.2002.35082
  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; 23:883-7. https://doi.org/10.1007/s00590-012-1112-y
  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;23:535-43. https://doi.org/10.1007/s00590-012-1036-6
  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;40:655-7. https://doi.org/10.5999/aps.2013.40.5.655
  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: 387-95. https://doi.org/10.1177/1753193411431048
  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. https://doi.org/10.1007/s10195-011-0166-7
  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;20:841-55.