METACARPAL FRACTURES TREATMENT: COMPARASION BETWEEN KIRSCHNER WIRE AND INTRAMEDULLARY SCREW

Jesus, Bruno Cesar Silva de; Silva, Clóvis Rodrigo Guimarães Braz Pereira da; Cardoso, Rodrigo Domiciano; Mauad, Vitor Augusto Queiroz; Alves, Rafael Saleme; Pinto, Fernando Nogueira Zambone

doi:10.1590/1413-785220233103e266948

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Acta Ortopédica Brasileira

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Original Article, Hand • Acta Ortop Bras 31 (spe3) • 2023 • https://doi.org/10.1590/1413-785220233103e266948 copy

METACARPAL FRACTURES TREATMENT: COMPARASION BETWEEN KIRSCHNER WIRE AND INTRAMEDULLARY SCREW

TRATAMENTO DE FRATURAS METACARPAIS: COMPARAÇÃO ENTRE FIOS DE KIRSCHNER E FIXAÇÃO INTRAMEDULAR

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS).

Objectives:

Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients’ medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS.

Results:

The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group.

Conclusion:

The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

Keywords:
Bone Fracture; Metacarpus; Kirschner Wires; Fracture Fixation, Intramedullary; Trauma

	K-wire	IMCS
Age (interval)	30 years (15-47 years)	32 years (23-39 years)
Gender (Men:Women)	05:00	04:01
Trauma of the dominant hand	40%	80%
Smoker	40%	60%
Average duration of immobilization after surgery	6 weeks (±0)	4 weeks e 4 days (± 30 days)
Average time span for radiographic	57 days (± 16)	47 days (±7,6)
Average time span for patients to go back to work ^* * One member of the K-wire group went back to work seven months later because of Social Security-related issues at the Brazilian Social Security Institute (INSS); One member of the IMCS group was unemployed when she got the injury.	2 months e 22 days (± 13 days)	2 months (±36 days)
Results of limb functionality (0-100 points in DASH)	2 (±2,1)	2,5 (±2,8)
Rotational deviation	0	0
% of postsurgical handgrip strength (interval) ^ % of postsurgical handgrip strength when compared with the contralateral hand, having corrected its strength bearing in mind the limb dominance.	93,9% (84,9-99,9%)	95,4% (87,9-110%)
Number of patients presenting loss in the range of motion (TAM) ^* ***** Patients belonging to the K-wire group showed losses of 30° and 48°; the only patient belonging to the IMCS group who showed a loss of 25° had a surgery-related complication (intra-articular screw fixation).	2	1
Evaluation results of the range of motion (TAM) ^** ****** TAM – total range of motion (extension and flexion) of the metacarpophalangeal joints, and of the proximal and distal interphalangeal joints.
Normal hand	280 (±13,6)	286 (±10,2)
Postsurgical hand	264 (±15)	281 (±12,8)
% of patients who showed an excellent recovery after surgery	80% (4/5)	100% (5/5)

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[1] Correspondence: Bruno Cesar Silva de Jesus. Faculdade de Medicina do ABC (FMABC). Lauro Gomes Av, 2000. Vila Sacadura Cabral, Santo André, Sao Paulo, Brazil. 09060-870 . brunojec@hotmail.com