Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization

Abstract

Objective: This study aims to evaluate the outcomes of single intramedullary K-wire fixation in nonthumb, metacarpal shaft fractures with immediate postoperative hand mobilization without any immobilization.

Method: This is a retrospective case series conducted from January 2019 to December 2022. We included patients with closed, simple transverse, or short oblique metacarpal shaft fracture treated with single, 1.4 mm, intramedullary K-wire fixation. Gentle postoperative range of motion exercise was encouraged in every patient without any hand, finger, or wrist motion restriction material. Clinical outcomes were evaluated with total active flexion; grip strength; disability of arm, shoulder, and hand (DASH) score; and the American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score.

Results: This study included 34 patients, 25 males and 9 females with a mean age of 33.14 years (ranging 18-59). A total of 43 metacarpal shafts were treated. The mean DASH score at two and 6 weeks postoperative was 41.5 (ranging 19.16-60.34) and 9.58 (ranging 0.83-23.27). The mean final DASH score at last follow-up was 3.48 (ranging 0-8.33). Mean TAF at 2 weeks postoperative, 6 weeks postoperative, and at final follow-up was 203.8 (ranging 185-240), 238.2 (ranging 220-270), and 259.25 (ranging 240-270) degrees, respectively. The mean grip strength of the injured hand was 66.14 and 86.1% of the uninjured hand at 6 weeks and 3 months postoperative. There was no nonunion, malrotation, or infection. In conclusion, single intramedullary K-wire fixation gives excellent outcomes in the treatment of single or multiple, simple, metacarpal shaft fractures without the need of postoperative immobilization.

Figure 1

The steps in the K-wire prebending: (a) how to measure the length of the implant, (b) using the blunt end of the K-wire as an implant tip, the tip was bent up about five degrees and the proximal part of the K-wire was bent up about 45 degrees, (c) the loop was made by twisting the wire around the plier, (d) the plier is used to further compress the loop diameter, (e) cut and remove the remaining K-wire, (f) the cut proximal K-wire end was twisted to align with the implant, thus preventing the present of any sharp edge that could irritate the soft tissue, and (g) the final shape of the implant.

Figure 2

A 19-year-old male, with fracture of the fourth and fifth metacarpal shafts: (a) preoperative radiographs, (b) 2 weeks postoperative range of motion, (c) at 6 weeks after the operation, the patient's radiographs showed a sign of bone union. He regained excellent ASSH TAF score. His TAF of his left ring finger was 265 degrees (normal: 270). His grip strength was 71.15% of the contralateral hand. His DASH score was 14.16. He had lost to follow-up after implant removal.

Figure 3

A 23-year-old male with fracture of the fourth and fifth metacarpal shafts: (a) pre and postoperative radiographs of his right hand, (b) clinical pictures of the patient's hand ROM at 6 weeks postoperative, (c) clinical pictures of his ROM at 3 months after surgery. The radiograph showed bone union. He regained full ROM. His DASH score was 5 and his grip strength was 77.46% compared to his left hand.

Figure 4

A 23-year-old female with fracture of the fourth metacarpal shaft of her left hand: (a) preoperative radiographs, (b) postoperative radiographs and clinical pictures of her hand motion at 2 weeks, (c) the patient regained full ROM at 6 weeks after the operation, and (d) uneventful bone healing and excellent functional outcomes were observed at 5 months. Her grip strength was 86.48% and the DASH score was zero. She denied further appointment.

Figure 5

A 51-year-old male with fracture of the fifth metacarpal shaft of the right hand: (a) preoperative radiographs, (b) postoperative radiographs at 2 weeks after surgery, and (c) at 6 weeks postoperative, the patient had dorsal callus bump over the fracture site. He had 15 degrees extension lag, but with full finger flexion. His grip strength was 82.85% and his DASH score was 3.33. He was satisfied with the treatment result and denied further appointment.