Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires.

BACKGROUND: The vast majority of metacarpal bone fractures are stable and are treated conservatively; however, when surgical intervention is to be preferred, many different operative procedures have been described. The purpose of this prospective study was to assess the anatomic and functional outcome of percutaneous transverse fixation with Kirschner wires (K-wires) of closed metacarpal neck, shaft. and intra-articular fractures of the base of the fifth metacarpal. METHODS: Twenty-four consecutive patients with 25 closed metacarpal fractures were treated with this technique between 1999 and 2001. Under fluoroscopy, closed reduction and osteosynthesis with three K-wires, one proximally and two distally, was performed on the fracture site. All patients were reviewed clinically and radiologically after 3 weeks, 6 weeks, and 3 months. RESULTS: The postoperative dorsal angulation ranged from 0 to 3 degrees. No measurable metacarpal shortening was observed. Callus formation was obvious in all fractures at 6 weeks. No complications were recorded, and all patients were cosmetically and functionally satisfied. CONCLUSION: Treatment of closed metacarpal neck, shaft, and intra-articular fractures of the base of the fifth metacarpal with percutaneous transverse pinning, using two K-wires distally and one proximally, has shown excellent functional and anatomic outcome.

Functional evaluation after primary flexor tendon repair in zone II.

The purpose of this prospective study was to evaluate the results of primary treatment of flexor tendon laceration in zone II according to Verdan's zone system. Special emphasis was given to the postoperative rehabilitation program. Nineteen patients (23 fingers) with laceration of the flexor tendons in zone II were treated operatively. Twelve males and seven females were included in the study. Their mean age was 28 years (range, 16 to 50 years). In 12 cases a concomitant laceration of the digital nerve was present. In all cases primary repair of all injured tendons and nerves was performed and a dorsal splint was applied. On the third to fifth postoperative day an exercise program commenced involving passive flexion-active extension of the injured fingers. Eighteen (22 fingers) of 19 patients completed the follow-up. The results were evaluated according to Strickland's original classification system. The result was excellent in 15 cases, good in five and fair in two. After primary repair of injured flexor tendons, a program of close follow-up, early protected motion and unrestricted motion of the interphalangeal joints offers the best chance of restoring optimal function to the hand.