A Comparison of the Effect of Wrist Immobilisation on the Outcomes of Cerclage Wire Fixation of Spiral or Oblique Metacarpal Fractures

Abstract

Background: There are limited studies on cerclage wiring (CW) for simple spiral or oblique metacarpal shaft fractures. It is generally believed that this fixation technique is not rigid and requires postoperative immobilisation. This study aims to compare the effect of wrist immobilisation on the outcomes of cerclage wire fixation of spiral or oblique metacarpal fractures. Methods: The study included 29 patients, divided into two groups: Group A, with 14 patients who had no postoperative immobilisation, and Group B, with 15 patients who were splinted after surgery. The primary outcomes were metacarpophalangeal (MCP) joint range of motion (ROM), quick disabilities of arm, shoulder and hand (Q-DASH) score and patient-rated wrist evaluation (PRWE) score. All patients were followed until 12 weeks post-surgery. Results: Patients in Group A had significantly better MCP joint ROM at 2 and 4 postoperative weeks. The Q-DASH and PRWE scores were significantly better in Group A at 2 postoperative weeks but showed no difference after the splint was removed. All fractures united within 12 weeks after surgery. There were no cases of infection, implant breakage or re-fracture. Conclusions: Postoperative immobilisation after CW in simple spiral or oblique metacarpal shaft fractures led to reduced MCP joint ROM and functional outcomes in the early postoperative period. Early gentle mobilisation can be encouraged immediately following surgery. Level of Evidence: Level III (Therapeutic).

Keywords: Cerclage wiring; Early mobilisation; Metacarpal fractures; Spiral or oblique fractures; WALANT surgery.