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Original Article Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures
Hong-ki Jin, Hyoung Min Kim, Yong Seung Oh, Jihoon Kim
Journal of Musculoskeletal Trauma 2021;34(1):23-29.
DOI: https://doi.org/10.12671/jkfs.2021.34.1.23
Published online: January 31, 2021
Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea

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Abstract

Purpose
This study was designed to evaluate the radiological and clinical outcomes of a new surgical technique—customized staple fixation using K-wire—in displaced metacarpal neck or base fractures. Materials and Methods: From November 2016 to May 2017, 13 unstable metacarpal neck and base fractures (10 patients) were treated with II-shaped customized K-wire staples fixation, after performing open reductions through minimal dorsal incisions. The radiological and clinical outcomes were retrospectively evaluated. Results: A mean of 2.6 staples were used for each fracture fixation. Preoperative angulation of 36.3°was reduced to 3.1° postoperatively. A week after surgery, the volar short arm splint was replaced with a dorsal splint to initiate active range of motion exercise, and the splint was subsequently removed after 3 weeks. The radiologic union was achieved at a mean of 5.1 weeks, and total active motion was recovered at a mean of 7.4 weeks. On a mean, K-wire staples were removed at 16.5 weeks after the surgery, and the mean treatment took 18.6 weeks. At the final follow-up (at mean 27.3 weeks), no significant difference was observed for total active motion of the digits and grip strength, when compared to the contralateral hand. Complete union was achieved in all fractures without deformity, or complications such as infection or nerve injury. All patients were satisfied with the cosmetic and functional outcomes. Conclusion: K-wire stapling is an effective alternative modality in treating unstable displaced metacarpal neck or base fractures. It requires minimal incision to enable open reduction. In addition, early mobilization is ensured through the rigid fixations. Moreover, it prevents postoperative joint stiffness and reduces the time needed for treatment.


J Korean Fract Soc. 2021 Jan;34(1):23-29. Korean.
Published online Jan 25, 2021.
https://doi.org/10.12671/jkfs.2021.34.1.23
Copyright © 2021 The Korean Fracture Society. All rights reserved.
Original Article

Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures

Hong-ki Jin, M.D., Hyoung Min Kim, M.D., Ph.D., Yong Seung Oh, M.D., and Jihoon Kim, M.D.
    • Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea.
  • Correspondence to: Yong Seung Oh, M.D. Department of Orthopedic Surgery, Good Samsun Hospital, 326 Gayadaero, Sasang-gu, Busan 47007, Korea. Tel: +82-51-310-9289, Fax: +82-51-310-9348, Email: oyong79@naver.com
Received October 08, 2020; Revised November 20, 2020; Accepted January 04, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to evaluate the radiological and clinical outcomes of a new surgical technique—customized staple fixation using K-wire—in displaced metacarpal neck or base fractures.

Materials and Methods

From November 2016 to May 2017, 13 unstable metacarpal neck and base fractures (10 patients) were treated with II-shaped customized K-wire staples fixation, after performing open reductions through minimal dorsal incisions. The radiological and clinical outcomes were retrospectively evaluated.

Results

A mean of 2.6 staples were used for each fracture fixation. Preoperative angulation of 36.3° was reduced to 3.1° postoperatively. A week after surgery, the volar short arm splint was replaced with a dorsal splint to initiate active range of motion exercise, and the splint was subsequently removed after 3 weeks. The radiologic union was achieved at a mean of 5.1 weeks, and total active motion was recovered at a mean of 7.4 weeks. On a mean, K-wire staples were removed at 16.5 weeks after the surgery, and the mean treatment took 18.6 weeks. At the final follow-up (at mean 27.3 weeks), no significant difference was observed for total active motion of the digits and grip strength, when compared to the contralateral hand. Complete union was achieved in all fractures without deformity, or complications such as infection or nerve injury. All patients were satisfied with the cosmetic and functional outcomes.

Conclusion

K-wire stapling is an effective alternative modality in treating unstable displaced metacarpal neck or base fractures. It requires minimal incision to enable open reduction. In addition, early mobilization is ensured through the rigid fixations. Moreover, it prevents postoperative joint stiffness and reduces the time needed for treatment.

Keywords
Metacarpal fracture, Neck, Base, Staple, Open reduction

Figures

Fig. 1
A 2-cm longitudinal incision was made at the fracture site. After open reduction, the fracture site was temporarily fixed using the K-wire.

Fig. 2
Procedure of customized K-wire stapling technique.

Fig. 3
(A) 5th metacarpal neck fracture with 31° dorsal angulation after trauma. (B) Postoperative x-ray shows reduction and secure fixation of the fracture site using 2 staple fixation. (C) Staples were removed 3 months after trauma.

Fig. 4
(A) Fracture and lateral subluxation of the 4th metacarpal base, and 68° dorsal angulation after a punch injury with closed fist. (B) Postoperative x-ray shows reduction and secure fixation of the fracture site. (C) Staples were removed 1 year after trauma.

Fig. 5
At 1-year follow-up, normal total active motion of digits was restored without deformity or angulation.

Fig. 6
(A) Conventional unicortical staple fixation method, ordinary staple. (B, C) Bicortical fixation of the K-wire staple.

Notes

Financial support:None.

Conflict of interests:None.

References

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    Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures
    J Korean Fract Soc. 2021;34(1):23-29.   Published online January 31, 2021
    DOI: https://doi.org/10.12671/jkfs.2021.34.1.23
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