Arch Hand Microsurg 2018; 23(3): 175-183  
The Treatment Outcomes of the Metacarpal Shaft and Neck Comminuted Fractures Using Modified Percutaneous Retrograde Intramedullary Kirschner Wire Fixation
Seok Woo Hong1, Young Ho Lee2, Min Bom Kim2, Goo Hyun Baek2
1Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
2Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
Correspondence to: Young Ho Lee
Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
TEL: +82-2-2072-0894, FAX: +82-2-764-2718, E-mail: orthoyhl@snu.ac.kr
Received: July 24, 2018; Revised: August 10, 2018; Accepted: August 10, 2018; Published online: September 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

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: The purpose of the present study was to verify the therapeutic efficiency of modified percutaneous retrograde intramedullary fixation using Kirschner wire in metacarpal shaft and neck comminuted fractures.
Methods: A total of 17 cases in 15 patients with metacarpal shaft and neck comminuted fractures diagnosed by physical examination and imaging modalities were included. For radiologic evaluations, the changes of degree of metacarpal bone shortening and that of dorsal angulation of metacarpal bone between before and six months after surgery were measured. Clinical evaluations were assessed by the timing of clinical union and visual analog scale (VAS), total active range of motion (TAM) of metacarpophalangeal joint, and complications at six months postoperatively.
Results: In all cases, union was achieved without additional treatment. The degree of the metacarpal bone shortening and the degree of dorsal angulation of metacarpal bone were improved significantly at six months after operation. The clinical bone union was completed average 6.49 weeks after surgery. The mean VAS was 1.35, and the mean TAM of metacarpophalangeal joint was 85.88° at 6 months postoperatively. Complications including nonunion, malunion, and refracture were not observed during follow-up period.
Conclusion: Modified percutaneous retrograde intramedullary fixation using Kirschner wire showed satisfactory treatment results in metacarpal shaft and neck comminuted fractures. Thus, this method could be recommended as one of treatment modalities for metacarpal shaft and neck comminuted fractures due to its easy procedures and low occurrence rate of associate complications.
Keywords: Metacarpal neck, Metacarpal shaft, Comminuted fracture, Retrograde, Intramedullary nailing


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