Comparative Study Between Intramedullary K-wire Fixation Versus Transverse Pinning in Treatment of Fifth Metacarpal Neck Fracture

Abstract

Background: Fifth metacarpals and phalangeal fractures are common, and neck fractures of the fifth metacarpal is the commonest. Improper treatment is associated with negative economic impact due to its associated disabilities. Aim of the work: To compare between intra-medullary and transvers K-wires for fifth metacarpal neck fractures. Patients and Methods:Thirty patients with 5th metacarpal neck fracture were included. Fifteen treated by intramedullary k-wire fixation, and fifteen treated by transverse k-wire pinning. Preoperatively, patients were evaluated by clinical, radiological and laboratory studies. Postoperatively, they were assessed clinically and by imaging studies. Objective assessment had been achieved by the total active range of motion [TAM] and hand-grip strength. Results: Both groups were comparable as regard to patient and injury characteristics. Punch was the most common mechanism of injury. The right side was affected in 80%, and the transverse fracture was the most common [reported in 53.3%]. Finally, outcome was slightly better in group 1, except for one patient of non-union. The results based on TAM% were excellent, good, fair and poor among 60.0%, 26.7%, 6.7% and 6.7% in group 1, compared to 83.3%, 40.0%, 0.0% and 6.7% in group 2 with the same order. The time to union ranged between 6 and 14 weeks. Finally, complications were reported in 20% of group 1 and 33.3% of group 2. Conclusion: Intramedullary K-wire Fixation and Transverse Pinning provide an optimal treatment options for Fifth Metacarpal Neck Fracture. Intramedullary K-wire Fixation provide slightly better outcome. However, the superiority is not statistically significant.

Keywords

• fifth metacarpal
• k-wire
• intramedullary
• pinning
• fracture