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Metacarpal Fracture Fixation Using Intramedullary Pins (IM Pins) Compared to Kirschner Wires (K-Wires)
Zachary A. Reese; Abdo Bachoura; Sidney M. Jacoby; Randall W. Culp
Philadelphia Hand Center, Philadelphia, PA

Introduction: Metacarpal fractures are most often treated nonoperatively, but in the event of multiple fractures, unstable metacarpals, or inadequate closed reduction, open reduction and internal fixation (ORIF) is indicated. ORIF may be performed with intramedullary pins, K-wires, or plates and screws. The purpose of this study is to assess treatment outcomes of metacarpal fractures fixed with IM pins in comparison to treatment with temporary K-wire fixation.

Materials and Methods: The medical records of patients that underwent metacarpal fracture fixation between 2005 and 2011 were retrospectively reviewed. Patient demographics, surgical technique, duration of surgery, postoperative range of motion, final grip strength, and complications were collected from the medical records. Range of motion measurements of the treated digit were measured post-operatively and the data reported as the total active motion (TAM). A Quick-DASH telephone survey was conducted in June 2013.

Results: The study population included 97 patients with 110 fractures: 77 males and 20 females, with a mean age of 35 (range, 10-80). No significant differences in patient age or gender were noted between groups. Fifty-six fractures were treated with an intramedullary pin with an average surgery time of 17 minutes, while 54 fractures were treated with 1 to 3 0.045 K-wires with an average surgery time of 14 minutes, p=0.24. The clinical follow-up duration averaged 7 weeks for the IM pin group: the TAM was 216; grip strength of the affected hand was 71% of the contralateral hand; complications developed in 9 cases (16%) including hardware problems (n=1) and extensor adhesions requiring tenolysis (n=3). The mean QuickDASH for the IM pin group was 0.64 (range, 0-6.8). The clinical follow-up duration for the K-wire group averaged 9 weeks: the TAM was 207; grip strength of the affected hand was 75% of the contralateral hand; complications arose in 6 cases (11%) and included superficial infection (n=4). The mean QuickDASH score was 1.65 (range, 0-2.27). No significant difference was found in any of the preceding outcomes. Twenty-two of the IM pins were removed in the operating room at an average of 80 days post-surgery due to complications or patient preference, and all of the K-wires were removed in the clinic at an average of 27 days post-surgery, p=0.002.

Conclusions: Based on this study, it appears that IM pinning and K-wire fixation of metacarpal fractures have similar outcomes with respect to operative time, TAM, grip strength, post-operative complications, and patient-rated outcomes.

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