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Fixation of Unstable Metacarpal Neck Fractures: Comparison of Crossed K-Wires and Intramedullary Headless Screw Fixation
Eitan Melamed, MD; Omri Ayalon, MD; Matin Lendhey, Msc; Oran Kennedy, PhD; John T. Capo, MD
NYU Hospital for Joint Diseases, New York, NY

Background: Numerous constructs are used in the fixation of metacarpal neck fractures. Currently one of the most common methods is K wire fixation. Recently, intramedullary headless screw (IMHS) has shown promise as an alternative to K wire fixation of metacarpal fractures. The purpose of this study was to compare the biomechanical performance of IMHS versus standard retrograde crossed K-wire fixation in a simulated metacarpal neck fracture model.

Methods: Transverse metacarpal neck fractures were created in 29 human cadaveric metacarpals. The specimens were randomly fixed with 3.0mm IMHS or retrograde crossed 0.045 inch K-wires. Constructs were then loaded to failure in cantilever bending. Stiffness, peak load to failure, maximal displacement and energy absorption were measured from the force-displacement curve. Data were analyzed via T test.

Results: The K wire group and the IMHS group had similar stiffness (15.188.07 N/mm, and 15.779.46 N/mm, respectively). Statistical difference was only found in maximal displacement which was higher in the K wire group (23.56 3.72mm versus 20.60 4.18mm). A statistically significant difference was not detected between the peak loads, and energy absorption of the K wires and IMHS.

Conclusion: For transverse metacarpal neck fractures, IMHS provides similar fixation to K-wires with limited dissection and without exposed hardware or the potential for pin track infection and collateral ligament tethering. The implant is inserted using a minimally invasive technique and would be suitable for unstable metacarpal neck fractures.

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