Clinical Outcomes of Retrograde Percutaneous Pinning for Shaft Fracture of Metacarpal Bone: A Case Series.

Abstract

Introduction: Surgical treatment should be considered for metacarpal fractures that have severe angulation or shortening. Percutaneous pinning is a useful technique in that it is minimally invasive. Insertion of Kirschner wires using retrograde pinning is easier than that using antegrade or transverse pinning. On the other hand, anterograde pinning is also used for metacarpal shaft and neck fractures, but some complications such as perforation of the metacarpal head or laceration of the extensor tendons can occur. The purpose of this study is to evaluate the functional outcomes of simple retrograde pinning.

Materials and methods: Thirteen patients (15 fingers) with simple metacarpal shaft fractures were enrolled in this prospective study. All patients were treated using percutaneous retrograde pinning following a brachial plexus block. Two intramedullary Kirschner wires were inserted from the metacarpal head to its base. Clinical outcomes included range of motion (ROM), post-operative complications, and evaluation using the Quick Disabilities of the Arm, Shoulder, and Hand score at final follow-up.

Results: ROM in extension/flexion for each joint at the final follow-up was: Metacarpal phalangeal joint 3.1°/87.1°; proximal interphalangeal joint 2.0°/103.3°; and DIP joint 0°/74.1°. The percent total active ROM was 91.9% and the Quick-DASH score was 2.7 out of 100. Pin tract infections occurred in two fingers and were treated with oral antibiotics.

Conclusions: In this study, retrograde Kirschner wire fixation was an acceptable technique for the treatment of displaced metacarpal fractures. This simple technique is suitable, especially for young patients in whom fractures are extraarticular and simple. It can correct deformity less invasively and provide good clinical outcomes.