Early Outcomes of a Simple Intramedullary Fixation Technique for Fifth Metacarpal Neck and Distal Diaphyseal...

Fifth metacarpal neck and distal diaphyseal fractures with severe angulation, displacement, or malrotation may benefit from surgery. Fixation approaches include antegrade and retrograde intramedullary fixation, transmetacarpal Kirschner wires (K-wire), and plate fixation. K-wires are a particularly promising option due to their simple, non-invasive, and cost-efficient nature. This study describes a novel K-wire technique for fracture fixation and presents early outcomes and complications. 21 patients with fifth metacarpal neck or distal shaft fractures were retrospectively reviewed after treatment with an antegrade intramedullary K-wire with a "T-handle" bend proximally, a gentle bend distally, and a transosseous wire transfixing the fourth and fifth metacarpal heads to control rotation. Patient characteristics, radiographic data, and postoperative outcomes were collected. Patients were immobilized in a cast or splint for an average of 5 weeks (range: 3.7 to 9.3 weeks). Mean follow-up was 8.4 weeks (range: 3.7 to 27.7 weeks). Mean preoperative angulation was 49.7 degrees (SD: 13.7 degrees, range: 19 to 71 degrees) and mean postoperative angulation was 17.5 degrees (SD: 4.2 degrees, range: 11 to 26 degrees). The operative small finger metacarpal phalangeal joint achieved an average flexion of 72.1 degrees compared with 89.6 degrees on the nonoperative side ( P =0.001). Four patients developed cellulitis around a K-wire and were successfully treated with pin removal and oral antibiotics. Two patients developed numbness over the dorsal small finger. There were no nonunions. In conclusion, severely angulated, displaced, or malrotated fifth metacarpal neck and distal shaft fractures can be effectively treated with this novel, simple, inexpensive, and minimally invasive K-wire technique.