scholarly journals Treatment of Metacarpal Fractures with Retrograde Intramedullary K Wires without Metacarpophalyngeal Joint Entry: A Novel and Practical Technique

2021 ◽  
Vol 10 (1) ◽  
pp. 55-61
Author(s):  
Mehmet Akdemir ◽  
Çağdaş Biçen ◽  
Mehmet Aykut Türken ◽  
Ahmet Cemil Turan ◽  
Abdullah Meriç Ünal ◽  
...  
Keyword(s):  
Metacarpal Fractures ◽  
K Wires

scholarly journals Assessment of Forearm Rotational Control Using 4 Upper Extremity Immobilization Constructs

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 202-208
Author(s):  
Ayesha M. Rahman ◽  
Nicole Montero-Lopez ◽  
Richard M. Hinds ◽  
Michael Gottschalk ◽  
Eitan Melamed ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Fluoroscopic Guidance ◽  
Digital Photographs ◽  
Radioulnar Joint ◽  
Metacarpal Fractures ◽  
Additional Stability ◽  
K Wires ◽  
Immobilization Techniques

Background: Forearm immobilization techniques are commonly used to manage distal radius, scaphoid, and metacarpal fractures. The purpose of our study was to compare the degree of rotational immobilization provided by a sugar-tong splint (STS), short arm cast (SAC), Munster cast (MC), and long arm cast (LAC) at the level of the distal radioulnar joint (DRUJ), carpus, and metacarpals. Methods: Seven cadaveric upper extremity specimens were mounted to a custom jig with the ulnohumeral joint fixated in 90° of flexion. Supination and pronation were unrestricted. K-wires were placed in the distal radius, scaphoid, and metacarpals using fluoroscopic guidance to measure the total arc of rotation referenced to the ulnar ex-fix pin. Baseline measurements followed by sequential immobilization with well-molded STS, SAC, MC, and LAC were obtained with 1.25, 2.5, and 3.75 ft-lb of supination and pronation force directed through the metacarpal K-wire. Each condition was tested 3 times. Digital photographs were taken perpendicular to the ulnar axis to analyze the total arc of motion. Results: The most effective constructs from least to greatest allowed rotational arcs were LAC, MC, SAC, and STS. Above-elbow constructs (MC, LAC) demonstrated superior immobilization compared with below-elbow constructs (SAC) ( P < .001). Circumferential constructs (SAC, MC, LAC) were superior to the noncircumferential construct (STS) ( P < .001). There were no significant differences between the MC and LAC in all conditions tested. Conclusions: Both circumferential and proximally extended immobilization independently improved rotational control of the wrist. However, extending immobilization proximal to the epicondyles did not confer additional stability.

scholarly journals Retrospective analysis of Intramedullary K-Wire fixation of Metacarpal Fractures

2021 ◽  
Vol 7 (2) ◽  
pp. 22-27
Author(s):  
Dr. Sunil Kumar Kirar ◽  
◽  
Dr. Sanjay Upadhyay ◽  
Dr. Sanat Singh ◽  
Dr. Atul Varshney ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Kirschner Wire ◽  
Functional Results ◽  
Clinical Results ◽  
Metacarpal Fractures ◽  
Kirschner Wire Fixation ◽  
Metacarpal Bones ◽  
Flexion Extension ◽  
Wire Fixation ◽  
K Wires

Introduction: The majority of fractures of the metacarpal bones occur at a young age.Most of thetimes these metacarpal fractures can be treated conservatively in a POP slab(cock up slab)producing good functional results.Surgery was indicated in patients with palmar dislocation of >30°and shortening of >5 mm.Our study aimed to evaluate the clinical results of all metacarpal fracturestreated surgically by intramedullary Kirschner-wire fixation presented in our hospital.Materials andMethods: It was a retrospective study in which we included 50 patients with metacarpalfractures(both open andclosed) that came in our hospital, treated surgically by closed reduction andwere fixed with two intramedullary k-wires. Result: K-wires were removed after 4 weekspostoperatively,under local anaesthesia in the OPD. Metacarpal joint functions (flexion, extension,rotation) were clinically followed up in all patients, on the median periodof6 months (3 months to 9months). In our study, we found in all patients,flexion and extension were normal on bothsides.Conclusion: Closed reduction and intramedullary k-wire fixation of metacarpal bone fracturesproduce good functional results in the longterm. We found a very low rate of complication and thusrecommendthis surgical method for the stabilization of all these types of fractures.

scholarly journals Safe approach for fixation of first metacarpal fractures: an anatomical study

2019 ◽  
Vol 45 (2) ◽  
pp. 136-139
Author(s):  
Alexander P. A. Greeven ◽  
Jorg Van Groningen ◽  
Alexander Poublon ◽  
Esther M. M. Van Lieshout ◽  
Gert-Jan Kleinrensink ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Safe Zone ◽  
Surgical Anatomy ◽  
Computer Assisted ◽  
Metacarpal Fractures ◽  
Dorsal Branch ◽  
Superficial Branch ◽  
K Wires ◽  
Minimally Invasive Fixation ◽  
Safe Approach

This anatomical study defines a safe zone for percutaneous or minimally invasive fixation of first metacarpal fractures in order to avoid injury of the superficial branch of the radial nerve and the dorsal branch of the radial artery. The courses of the nerve and artery branches were marked in 20 embalmed cadaver specimens. With computer-assisted surgical anatomy mapping, a large diversity in the anatomical patterns for the nerve and a consistent pattern for the artery were found. Based on these findings, we conclude that transfixation of the first and the second metacarpals with K-wires placed in the distal 75% of both the first and second metacarpals is the safest way to avoid damages to the nerve and artery branches during fracture fixation.

Intramedullary percutaneous fixation of metacarpal fractures: screw versus connected K-wires

2021 ◽  
Author(s):  
Belén García-Medrano ◽  
Sophie Honecker ◽  
Sybille Facca ◽  
Fernando Polo Simón ◽  
Pedro J. Delgado ◽  
...  
Keyword(s):  
Percutaneous Fixation ◽  
Metacarpal Fractures ◽  
K Wires

Threaded Intramedullary Nails Are Biomechanically Superior to Crossed K-wires for Metacarpal Neck Fractures

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Midhat Patel ◽  
Paulo Castañeda ◽  
David H. Campbell ◽  
Jill G. Putnam ◽  
Michael D. McKee
Keyword(s):  
Intramedullary Nail ◽  
Kirschner Wire ◽  
Ring Finger ◽  
Displacement Curve ◽  
Sharp Change ◽  
Metacarpal Fractures ◽  
Biomechanical Models ◽  
Wire Fixation ◽  
Point Bend ◽  
K Wires

Background Intramedullary nail (IMN) fixation of metacarpal fractures is an alternative to Kirschner wire (K-wire) fixation. The goal of this study was to compare the biomechanical properties of K-wire fixation with a threaded IMN (InNate; ExsoMed, Aliso Viejo, California). Methods The study design was based on previously described biomechanical models for evaluating metacarpal fractures. Sixteen fresh frozen small finger–matched and ring finger–matched pairs were randomized to either IMN or 0.045 in K-wire fixation after receiving a standardized neck osteotomy. Proper implant placement was confirmed with plain radiographs. Specimens then underwent loading in a 3-point bend configuration. Load to failure (LTF), stiffness, and fracture displacement were recorded. Mechanical failure was defined by a sharp change in the load-displacement curve. Results Age, sex, sidedness (left or right), and digit (ring or small finger) were evenly distributed between groups. The IMN had a significantly higher LTF than K-wires (546 N vs 154 N, P < .001). The K-wire fixation demonstrated plastic deformation between 75 and 150 N. Intramedullary nail stiffness was higher than that of K-wires (155.89 N/mm vs 59.28 N/mm, P < .001). Conclusions When surgical fixation is indicated for metacarpal neck and shaft fractures, the threaded IMN is biomechanically superior to crossed K-wires with the application of 3-point bend.

scholarly journals Evaluation of functional outcome of metacarpal fractures managed by operative techniques: a hospital based study

2021 ◽  
Author(s):  
Amit Kumar ◽  
Sanjeev Gupta ◽  
Vinay Badyal
Keyword(s):  
Functional Outcome ◽  
Traffic Accidents ◽  
Functional Disability ◽  
Road Traffic ◽  
Active Movement ◽  
Bony Union ◽  
Road Traffic Accidents ◽  
Operative Techniques ◽  
Metacarpal Fractures ◽  
K Wires

Background: Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents, fall, and assault. The main goal of treatment is to achieve the strong bony union without any functional disability. Aim of the study was evaluation of functional outcome of metacarpal fractures managed by operative techniques and to compare the efficacy of different operative techniques.Methods: A total of 50 patients managed by various operative techniques by using k-wires, screws and plates. Functional outcome was assessed by using total active movement (TAM) and disabilities of the arm, shoulder and hand (DASH) scoring system at 6th week, 3rd month and at 6th month.Results: A total 47 fractures united and three fractures mal-united at the time of final assessment. Overall excellent and good results were achieved in 94% cases.Conclusions: Our finding suggests that open reduction and internal fixation with k-wire is most preferable method among all other operative techniques.

scholarly journals Anatomic Assessment of K-Wire Trajectory for Transverse Percutaneous Fixation of Small Finger Metacarpal Fractures: A Cadaveric Study

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Louis C. Grandizio ◽  
Amy Speeckaert ◽  
Zach Kozick ◽  
Joel C. Klena
Keyword(s):  
Sagittal Plane ◽  
Kirschner Wire ◽  
Ring Finger ◽  
Cadaveric Study ◽  
Sagittal Profile ◽  
Metacarpal Fractures ◽  
Surgeon Training ◽  
Center Position ◽  
K Wires ◽  
Targeting Strategy

Background: The purpose of this cadaveric study is to evaluate the trajectory of percutaneous transverse Kirschner wire (K-wire) placement for fifth metacarpal fractures relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for the treatment of fifth metacarpal fractures. Methods: Using 12 unmatched fresh human upper limbs, we evaluated the trajectory of percutaneous transverse K-wire placement relative to the sagittal profile of the fifth metacarpal in order to develop a targeting strategy for treatment of fifth metacarpal fractures. The midpoint of the small and ring finger metacarpals in the sagittal plane was identified at 3 points. At each point, a K-wire was inserted from the small finger metacarpal into the midpoint of the ring finger metacarpal (“center-center” position). Results: The angle of the transverse K-wire relative to the table needed to achieve a center-center position averaged 20.8°, 18.9°, and 16.7° for the proximal diaphysis, middiaphysis, and the collateral recess, respectively. Approximately 80% of transversely placed K-wires obtained purchase in the long finger metacarpal. Conclusions: These results can serve as a guide to help surgeons in the accurate placement of percutaneous K-wires for small finger metacarpal fractures and may aid in surgeon training.

External Fixation of Closed Metacarpal and Phalangeal Fractures of Digits. A Prospective Study of One Hundred Consecutive Patients

2006 ◽  
Vol 31 (1) ◽  
pp. 30-40 ◽  
Author(s):  
K. MARGIĆ
Keyword(s):  
Prospective Study ◽  
External Fixation ◽  
Clinical Results ◽  
Multiple Fractures ◽  
Metacarpal Fractures ◽  
Metacarpal Bones ◽  
External Frame ◽  
K Wires ◽  
A Prospective Study ◽  
Phalangeal Fractures

Stable and undisplaced phalangeal and metacarpal fractures treated with strapping or functional splinting and controlled active exercises offer from about 70 to 80% of good results. The goal of treatment of closed unstable and displaced fractures should be to achieve similar or better outcome. External fixation combines the simplicity of time-honoured fixation with K-wires and an external frame to increase rigidity. This combination was used in a prospective study of 100 consecutive patients with closed fractures of the proximal and middle phalanges and the distal three-quarters of the metacarpal bones. Good clinical results (TAM ≥ 230°) were obtained in 76% of isolated phalangeal fractures, in all metacarpal fractures and in 89% of multiple fractures.

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