Percutaneous Kirschner wire antegrade fixation combined with wide-awake technique to administrate fourth and fifth metacarpal neck fractures

Abstract

Objective. To investigate the application and clinical effect of wide-awake technique combined with closed reduction and anterograde cross fixation with percutaneous Kirschner wire to treat fourth and fifth metacarpal neck fractures. Methods. A total of 19 male patients with closed fractures of the fourth and/or fifth metacarpal neck in Xuzhou Benevolent Hospital from January 2017 to December 2019 were included in the retrospective analysis. The patients were aged 11 to 45 years, with an average of 20.8 years. A total of 14 patients had a fifth metacarpal neck fracture, 3 patients had a fourth metacarpal neck fracture, and 2 patients had a fourth and fifth metacarpal neck fracture. A total of 17 patients had transverse fractures, and 2 patients had comminuted fractures. Four patients had a metacarpal neck fracture with patent epiphyseal plate. All 19 patients were treated via wide-awake technique combined with closed reduction and anterograde cross internal fixation with Pico Kirschner wire. The outcome measures were as follows: (1) operation time; (2) surgical complications; (3) postoperative follow-up observation of the affected side of the fourth and fifth metacarpal neck and metacarpal flexion angle, fracture healing, epiphyseal plate closure, metacarpal phalangeal, proximal interphalangeal, and distal interphalangeal joint active range of motion and grip strength; (4) At the last follow-up, the efficacy was evaluated according to the total active motion (TAM) method and the scale of quick disabilities of the arm, shoulder, and hand (Quick-DASH) method. Results. All the 19 patients in this group received surgery successfully. The operation time was 22 -46 min, with an average of 31.8 min. All fractures were healed without redisplacement. The healing time was 8-12 weeks (average 9.3 weeks). Eighteen patients were followed up for 6 -12 months. None of them had complications, including infection, local pain, redisplacement of fracture, metacarpal avascular necrosis or degeneration of metacarpophalangeal joint, or broken or withdrawn needle, and no premature epiphyseal closure was found in four cases of patent epiphyseal plate. The fourth and fifth metacarpal neck dorsal angulation decreased from 45.6° ± 14.6° before operation to 11.0° ± 1.7° after operation, and the difference was statistically significant (t=10.55, P<0.001). The patients' metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints had good active movement and hand shape without rotation deformity of the fingers. According to the evaluation of TAM and Quick-DASH, the efficacy of the 18 patients was excellent, and the rate of excellent and good outcome was 100%. Conclusions. Wide-awake technique combined with closed reduction and anterograde percutaneous Kirschner wire fixation is used to treat fourth and fifth metacarpal neck fractures. The fixation is reliable, without effect on the joints, which has a short healing time, and satisfactory curative effect. It is an excellent treatment choice.