Abstract

COMPARATIVE STUDY OF PERCUTANEOUS KIRSCHNER WIRES AND OPEN REDUCTION WITH INTERNAL FIXATION IN MANAGEMENT OF UNSTABLE METACARPAL SHAFT FRACTURE

*Gamal Salah Eldin Elmorsy, MD; Ahmed Abdelaziz Hassan, MD and Mostafa Abd Elfattah Bayomi MSC

Abstract

Purpose: The aim of this study is to assess the clinical and radiographic outcome of unstable metacarpal shaft fractures treated with intramedullary nail (IMN) kirschner wires with the results of such fractures treated with open reduction and internal fixation with platescrew (PS). Methods: Between 2014 and 2015, we treated 33, displaced, extra-articular metacarpal fractures operatively using 1 of 2 fixation methods: IMN or PS. Patient characteristics, mechanism of injury, pattern of fracture, and preoperative radiographic parameters were similar in both groups. The outcome data were collected and analyzed: total active motion of the digit (TAM), Disabilities of the Hand (DASH) scores and radiographic parameters. Results: 22/33 patients received IMN fixation and 11 patients received PS fixation. Mean follow-up time was 6 months in the IMN group and 5 months in the PS group. The mean and median total active motion were 237° and 250° for the IMN group, 228° and 248° for the PS group, with no statistically significant difference between the groups. The mean Disabilities of the hand score was 9.47 in the IMN group and 8.07 in the PS group. The association between hardware type and fracture location (middle or distal third of metacarpal) was not statistically significant. Time to radiographic healing also did not reach statistical significance between groups. Operative time was significantly shorter with use of the K wires. Five patients in the IMN group are displayed with loss of reduction; no failure was observed in the PS group. Conclusions: There were no significant differences in the clinical outcomes using either technique. Although operative time was shorter in the IMN group than in the PS group, the incidences of loss of reduction, penetration to the metacarpal- phalangel joint and secondary surgeries for hardware removal in the operating room were much higher in the IMN group the current results indicate that both procedures are highly effective in maintaining fracture restorations. Plate fixation provides earlier recovery of powerful hand function with shorter sick leave, which is of particular benefit to workers with specialized manual skills. And intramedullary nailing allows a wide range of finger motion.

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