Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 17 , ISSUE 2 ( May-August, 2022 ) > List of Articles

Original Article

Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study

Sabeel Ahmad, Tushar Gupta, Sajid Ansari, Aakriti Jain, Sitanshu Barik, Vivek Singh

Keywords : Crossed intramedullary, Hand, K-wire, Metacarpal, Phalanx

Citation Information : Ahmad S, Gupta T, Ansari S, Jain A, Barik S, Singh V. Intramedullary Crossed K-wire Fixation for the Hand Fractures is a Useful Treatment Modality: A Prospective Observational Study. 2022; 17 (2):74-80.

DOI: 10.5005/jp-journals-10080-1556

License: CC BY-NC-SA 4.0

Published Online: 28-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Various modalities of treatment have been used for the management of metacarpal and phalangeal fractures which include K-wire fixation, mini plates, lag screws fixation, intramedullary screw fixation and external fixator application. The aim of this study was to analyse complications and patient-related functional outcomes after antegrade or retrograde crossed intramedullary K-wire fixation of metacarpal and proximal phalangeal fractures. Methods: Thirty-one patients (36–fractures, 16–metacarpals, 20–proximal phalanx) meeting the study criteria were included in this prospective study. Fixation of the fractures was done by use of crossed intramedullary K-wire using the principles of 3-point fixation. Results: The mean preoperative angulation of the fractures noted in this study was 35.8° which was significantly reduced at final follow-up. Union was noted at a mean period of 4.2 ± 6.8 weeks. The mean range of motion at the metacarpophalangeal and proximal interphalangeal joint was 96.4% and 86.3%, respectively as compared to the opposite hand. Stiffness (n = 3, 14.2%) and persistent pain (n = 2, 9.5%) at the joints were the most common complications noted in this study. Conclusion: Crossed percutaneous intramedullary fixation of small bone fractures of the hand is a versatile method with advantages such as cost-effectiveness and lesser operative time when compared to other modalities of fixation. Earlier range of motion (ROM) exercises can be started due to preservation of gliding planes, no surgical wound along with good fracture stability and minimal hardware impingement.

PDF Share
  1. van Onselen EB, Karim RB, Hage JJ, et al. Prevalence and distribution of hand fractures. J Hand Surg Br 2003;28(5):491–495. DOI: 10.1016/s0266-7681(03)00103-7.
  2. De Jonge JJ, Kingma J, van der Lei B, et al. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury 1994;25(6):365–369. DOI: 10.1016/0020-1383(94)90127-9.
  3. Alphonsus CK. Principles in the management of a mangled hand. Indian J Plast Surg 2011;44(2):219–226. DOI: 10.4103/0970-0358.85343.
  4. Tintle SM, Baechler MF, Nanos GP 3rd, et al. Traumatic and trauma-related amputations: Part II: Upper extremity and future directions. J Bone Joint Surg Am 2010;92(18):2934–2945. DOI: 10.2106/JBJS.J.00258.
  5. Low CK, Wong HC, Low YP, et al. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br 1995;20(5):609–613. DOI: 10.1016/s0266-7681(05) 80120-2.
  6. Crockett DJ. Rigid fixation of bones of the hand using K-wires bonded with acrylic resin. Hand 1974;6(1):106–107. DOI: 10.1016/0072-968x(74)90022-9.
  7. Cziffer E. Static fixation of finger fractures. Hand Clin 1993;9(4): 639–650. PMID: 8300733.
  8. Fitoussi F, Ip WY, Chow SP. External fixation for comminuted phalangeal fractures. A biomechanical cadaver study. J Hand Surg Br 1996;21(6):760–764. DOI: 10.1016/s0266-7681(96)80182-3.
  9. Hoang D, Huang J. Antegrade intramedullary screw fixation: a novel approach to metacarpal fractures. J Hand Surg Glob Online 2019;1(4):229–235. DOI: 10.1016/j.jhsg.2019.07.002.
  10. Tobert DG, Klausmeyer M, Mudgal CS. Intramedullary fixation of metacarpal fractures using headless compression screws. J Hand Microsurg 2016;8(3):134–139. DOI: 10.1055/s-0036-1593390.
  11. Canale ST, Azar FM, Beaty JH. Campbell's operative orthopaedics. Elsevier; 2017.
  12. Adi M, Miyamoto H, Taleb C, et al. Percutaneous fixation of first metacarpal base fractures using locked K-wires: a series of 14 cases. Tech Hand Up Extrem Surg 2014;18(2):77–81. DOI: 10.1097/BTH.0000000000000040.
  13. De Spirito D. Percutaneous fixation of hand fractures using locked K-wires: mechanical analysis and clinical application. Tech Hand Up Extrem Surg 2013;17(3):134–143. DOI: 10.1097/BTH.0b013e31828afc48.
  14. Johansen A, Evans RJ, Stone MD, et al. Fracture incidence in England and Wales: a study based on the population of Cardiff. Injury 1997;28(9–10):655–660. DOI: 10.1016/s0020-1383(97)00144-7.
  15. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma 2015;29(8):e242–e244. DOI: 10.1097/BOT.0000000000000312.
  16. Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green's operative hand surgery E-Book: expert consult: online and print. Elsevier Health Sciences; 2010.
  17. Reformat DD, Nores GG, Lam G, et al. Outcome analysis of metacarpal and phalangeal fixation techniques at Bellevue Hospital. Ann Plast Surg 2018;81(4):407–410. DOI: 10.1097/SAP.0000000000001581.
  18. Pandey R, Soni N, Bhayana H, et al. Hand function outcome in closed small bone fractures treated by open reduction and internal fixation by mini plate or closed crossed pinning: a randomized controlled trail. Musculoskelet Surg 2019;103(1):99–105. DOI: 10.1007/s12306-018-0542-z.
  19. Wong H-C, Wong H-K, Wong K-Y. Stainless steel 2.0-mm locking compression plate osteosynthesis system for the fixation of comminuted hand fractures in Asian adults. J Orthop Trauma Rehabilitation 2011;15(2):57–61. DOI: 10.1016/j.jotr.2011.04.004.
  20. Desaldeleer-Le Sant A-S, Le Sant A, Beauthier-Landauer V, et al. Surgical management of closed, isolated proximal phalanx fractures in the long fingers: functional outcomes and complications of 87 fractures. Hand Surg Rehabil 2017;36(2):127–135. DOI: 10.1016/j.hansur.2016.08.009.
  21. Başar H, Başar B, Başçı O, et al. Comparison of treatment of oblique and spiral metacarpal and phalangeal fractures with mini plate plus screw or screw only. Arch Orthop Trauma Surg 2015;135(4): 499–504. DOI: 10.1007/s00402-015-2164-3.
  22. Kootstra TJM, Keizer J, Bhashyam A, et al. Patient-reported outcomes and complications after surgical fixation of 143 proximal phalanx fractures. J Hand Surg Am 2020;45(4):327–334. DOI: 10.1016/j.jhsa.2019.08.010.
  23. Boulton CL, Salzler M, Mudgal CS. Intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture: case report. J Hand Surg Am 2010;35(8):1260–1263. DOI: 10.1016/j.jhsa.2010.04.032.
  24. Curtis BD, Fajolu O, Ruff ME, et al. Fixation of metacarpal shaft fractures: biomechanical comparison of intramedullary nail crossed K-wires and plate-screw constructs. Orthop Surg 2015;7(3): 256–260. DOI: 10.1111/os.12195.
  25. Mishra AK, Adhikari V, Chalise P, et al. Jess fixator for metacarpal and phalangeal fracture. Nepal Med Coll J 2019;21(1):48–52. DOI: 10.3126/nmcj.v21i1.24853.
  26. Green DP, Anderson JR. Closed reduction and percutaneous pin fixation of fractured phalanges. J Bone Joint Surg Am 1973;55(8): 1651–1654. PMID: 4804987.
  27. Belsky MR, Eaton RG, Lane LB. Closed reduction and internal fixation of proximal phalangeal fractures. J Hand Surg Am 1984;9(5): 725–729. DOI: 10.1016/s0363-5023(84)80023-4.
  28. Joshi BB. Percutaneous internal fixation of fractures of the proximal phalanges. Hand 1976;8(1):86–92. DOI: 10.1016/0072-968x(76)90069-3.
  29. Hornbach EE, Cohen MS. Closed reduction and percutaneous pinning of fractures of the proximal phalanx. J Hand Surg Br 2001;26(1): 45–49. DOI: 10.1054/jhsb.2000.0524.
  30. Faruqui S, Stern PJ, Kiefhaber TR. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am 2012;37(7):1342–1348. DOI: 10.1016/j.jhsa.2012.04.019.
  31. van Bussel EM, Houwert RM, Kootstra TJM, et al. Antegrade intramedullary Kirschner-wire fixation of displaced metacarpal shaft fractures. Eur J Trauma Emerg Surg 2019;45(1):65–71. DOI: 10.1007/s00068-017-0836-0.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.