Limits...
Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone.

Moon SJ, Yang JW, Roh SY, Lee DC, Kim JS - Arch Plast Surg (2014)

Bottom Line: Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work.The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups.It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea.

ABSTRACT

Background: To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone.

Methods: A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire.

Results: During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group.

Conclusions: Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

No MeSH data available.


Related in: MedlinePlus

K-wire advancementWhen advancing the inserted K-wire, we used a small mallet to prevent inadequate supplementary bending of the K-wire.
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Figure 3: K-wire advancementWhen advancing the inserted K-wire, we used a small mallet to prevent inadequate supplementary bending of the K-wire.

Mentions: In case of the fifth metacarpal bone, the soft tissue and skin were pulled tightly to the radial side and a small incision was made on the ulnar side of the fifth metacarpal bone base level in order to avoid the anatomical location of the dorsal branch of the ulnar nerve (Fig. 2) [6,7,8]. Under the direct visualization of the notch of the cortex, the metaphyseal cortex was perforated with an awl, and the nails were advanced using a small mallet in order to prevent the supplementary bending of the nails during insertion (Fig. 3). The bent distal portions of the nails were placed at an angle to each other in order to resist the torsion forces (Fig. 4). The proximal "J-shaped hook" portions were fitted to the cortex (Fig. 5) [9].


Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone.

Moon SJ, Yang JW, Roh SY, Lee DC, Kim JS - Arch Plast Surg (2014)

K-wire advancementWhen advancing the inserted K-wire, we used a small mallet to prevent inadequate supplementary bending of the K-wire.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228223&req=5

Figure 3: K-wire advancementWhen advancing the inserted K-wire, we used a small mallet to prevent inadequate supplementary bending of the K-wire.
Mentions: In case of the fifth metacarpal bone, the soft tissue and skin were pulled tightly to the radial side and a small incision was made on the ulnar side of the fifth metacarpal bone base level in order to avoid the anatomical location of the dorsal branch of the ulnar nerve (Fig. 2) [6,7,8]. Under the direct visualization of the notch of the cortex, the metaphyseal cortex was perforated with an awl, and the nails were advanced using a small mallet in order to prevent the supplementary bending of the nails during insertion (Fig. 3). The bent distal portions of the nails were placed at an angle to each other in order to resist the torsion forces (Fig. 4). The proximal "J-shaped hook" portions were fitted to the cortex (Fig. 5) [9].

Bottom Line: Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work.The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups.It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Korea.

ABSTRACT

Background: To compare clinical and radiographic outcomes between intramedullary nail fixation and percutaneous K-wire fixation for fractures in the distal third portion of the metacarpal bone.

Methods: A single-institutional retrospective review identified 41 consecutive cases of metacarpal fractures between September 2009 and August 2013. Each of the cases met the inclusion criteria for closed, extra-articular fractures of the distal third of the metacarpal bone. The patients were divided by the method of fixation (intramedullary nailing or K-wire). Outcomes were compared for mean and median total active motion of the digit, radiographic parameters, and period until return to work. Complications and symptoms were determined by a questionnaire.

Results: During the period under review, 41 patients met the inclusion criteria, and the fractures were managed with either intramedullary nailing (n=19) or percutaneous K-wire fixation (n=22). The mean and median total active range of motion and radiographic healing showed no statistically significant difference between the two groups. No union failures were observed in either group. The mean operation time was shorter by an average of 14 minutes for the percutaneous K-wire fixation group. However, the intramedullary nailing group returned to work earlier by an average of 2.3 weeks. Complications were reported only in the K-wire fixation group.

Conclusions: Intramedullary nailing fixation is advisable for fractures in the distal third of the metacarpal bone. It provides early recovery of the range of motion, an earlier return to work, and lower complication rates, despite potentially requiring a wire removal procedure at the patient's request.

No MeSH data available.


Related in: MedlinePlus