Comparison of K-Wire and Plate Applications in Multiple Metacarpal Fractures

Öz

The aim of this study was to compare the mid-term clinical and radiological outcomes of intramedullary K-wire and plate-screw fixation in multiple extra-articular metacarpal fractures, and to evaluate the impact of fracture localization on functional outcomes. This retrospective study included 46 patients with at least two metacarpal shaft fractures between January 2018 and December 2023. Twenty patients underwent plate-screw fixation, while twenty-six patients received intramedullary K-wire osteosynthesis. Grip strength was measured using a digital dynamometer. Pain intensity was assessed with the Visual Analog Scale (VAS), and functional status was evaluated using the Michigan Hand Outcomes Questionnaire (MHQ). All patients were followed for a minimum of 15 months. Clinical scores were compared according to surgical method and fracture localization. Grip strength was significantly higher in the K-wire group (p=0.013). No statistically significant difference was observed between the groups in MHQ or VAS scores. Analysis based on fracture localization revealed that grip strength was significantly lower in 2nd and 3rd metacarpal fractures (p=0.036), whereas higher grip strength and lower pain scores were recorded in 4th and 5th metacarpal fractures (p=0.044). K-wire fixation is less invasive and provides better mid-term grip strength outcomes. However, functional scores were comparable between both techniques. Regardless of the surgical method, fractures involving the 2nd and 3rd metacarpals were associated with poorer prognosis. Fracture patterns and localization should be considered in treatment planning. Level II – Single-center randomized controlled trial.

Anahtar Kelimeler

• Functional outcome
• Grip strength
• Intramedullary K-wire fixation
• Multiple metacarpal fractures
• Plate-screw Osteosynthesis

Multipl Metakarp Kırıklarında K-Teli ve Plak Uygulamalarının Karşılaştırılması

Öz

Bu çalışmanın amacı, çoklu ekstraartiküler metakarp kırıklarında intramedüller K-teli ile plak–vida tespitinin orta dönem klinik ve radyolojik sonuçlarını karşılaştırmak ve kırık lokalizasyonunun fonksiyonel sonuçlar üzerindeki etkisini değerlendirmektir. Bu retrospektif çalışmaya Ocak 2018 ile Aralık 2023 arasında en az iki metakarp diafiz kırığı bulunan 46 hasta dâhil edilmiştir. Yirmi hastaya plak–vida tespiti uygulanırken, yirmi altı hastaya intramedüller K-teli osteosentezi yapılmıştır. Kavrama gücü dijital dinamometre ile ölçülmüştür. Ağrı şiddeti Görsel Analog Skala (VAS) ile, fonksiyonel durum ise Michigan El Sonuçları Anketi (MHQ) ile değerlendirilmiştir. Tüm hastalar en az 15 ay boyunca takip edilmiştir. Klinik skorlar cerrahi yönteme ve kırık lokalizasyonuna göre karşılaştırılmıştır. K-teli grubunda kavrama gücü anlamlı derecede daha yüksekti (p=0,013). MHQ veya VAS skorları açısından gruplar arasında istatistiksel olarak anlamlı bir fark gözlenmedi. Kırık lokalizasyonuna göre yapılan analizde, 2. ve 3. metakarp kırıklarında kavrama gücünün anlamlı derecede düşük olduğu (p=0,036), buna karşılık 4. ve 5. metakarp kırıklarında kavrama gücünün daha yüksek ve ağrı skorlarının daha düşük olduğu kaydedildi (p=0,044). K-teli tespiti daha az invazivdir ve orta dönemde daha iyi kavrama gücü sonuçları sağlar. Bununla birlikte, fonksiyonel skorlar her iki teknik arasında benzer bulunmuştur. Cerrahi yöntemden bağımsız olarak, 2. ve 3. metakarpı içeren kırıklar daha kötü prognozla ilişkilidir. Tedavi planlamasında kırık paterni ve lokalizasyonu dikkate alınmalıdır. Düzey II – Tek merkezli randomize kontrollü çalışma.

Anahtar Kelimeler

• Fonksiyonel sonuç
• Kavrama gücü
• İntramedüller K-teli tespiti
• Çoklu metakarp kırıkları
• Plak–vida osteosentezi

Kaynakça

1. Lambi AG, Rowland RJ, Brady NW, et al. Metacarpal fractures. J Hand Surg Eur Vol. 2023;48(2):42–50.
2. Bernstein ML, Chung KC. Hand fractures and their management: an international view. Injury. 2006;37(11):1043–1048.
3. Gould JS, Nicholson BG. Capsulectomy of the metacarpophalangeal and proximal interphalangeal joints. J Hand Surg. 1979;4(5):482–486.
4. Zhu X, Zhang H, Wu J, et al. Pin vs plate fixation for metacarpal fractures: a meta-analysis. J Orthop Surg Res. 2020;15(1):1–16.
5. Stern PJ. Fractures of the metacarpals and phalanges. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green’s Operative Hand Surgery. 4th ed. New York: Churchill Livingstone; 1998:711–726.
6. Jupiter JB, Hastings H 2nd, Capo JT. The treatment of complex fractures and fracture-dislocations of the hand. Instr Course Lect. 2010;59:333–341.
7. 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.
8. Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res. 2006;445:133–145.

9. Barton NJ. Fractures of the hand. J Bone Joint Surg Br. 1984;66(2):159–167.
10. Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol. 2007;32(6):626–636.
11. Kastanis GE, Siligardou MR, Chaniotakis C, et al. Acute Compartment Syndrome of the Hand Following Multiple Metacarpal Fractures: Current Concepts. Cureus. 2024;16(12):e75234.
12. Fusetti C, Meyer H, Borisch N, et al. Complications of plate fixation in metacarpal fractures. J Trauma. 2002;52(3):535–539.
13. Ushijima T, Ogawa H, Kojima T. Clinical outcomes of retrograde percutaneous pinning for shaft fracture of metacarpal bone: A case series. J Orthop Case Rep. 2025;15(4):239.
14. Delgado DA, Lambert BS, Boutris N, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. JAAOS Glob Res Rev. 2018;2(3):e088.
15. Ergen Hİ, Yiğit S, Maden T, et al. The Turkish version of the brief Michigan hand outcomes questionnaire: cross-cultural adaptation, validity, and reliability testing. Acta Orthop Traumatol Turc. 2024;58(5):286-287.
16. Marjoua Y, Eberlin KR, Mudgal CS. Multiple displaced metacarpal fractures. J Hand Surg Am. 2015;40(9):1869–1870.
17. Kim BS, Cho D, et al. Operative treatment of metacarpal shaft fracture. J Korean Soc Fractures. 1999;12(3):720–726.
18. Royle SG. Rotational deformity following metacarpal fracture. J Hand Surg [Br]. 1990;15(1):124–125.
19. Tannenbaum EP, Burns GT, Oak NR, et al. Comparison of 2-dimensional and 3-dimensional metacarpal fracture plating constructs under cyclic loading. J Hand Surg Am. 2017;42(3):e159–e165.
20. Poolman RW, Goslings JC, Lee JB, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev. 2005;(2):CD003210.
21. Melamed E, Joo L, Lin E, et al. Fixation versus percutaneous pinning for unstable metacarpal fractures: a meta-analysis. J Hand Surg Asian Pac Vol. 2017;22(1):29–34.
22. Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998;23(5):827–832.
23. Murray JF, Carman W, MacKenzie JK. Transmetacarpal amputation of the index finger: a clinical assessment of hand strength and complications. J Hand Surg Am. 1977;2(6):471–481.
24. Ejeskär A, Ortengren R. Isolated finger flexion force — a methodological study. Hand. 1981;13(3):223–230.
25. Hazelton FT, Smidt GL, Flatt AE, et al. The influence of wrist position on the force produced by the finger flexors. J Biomech. 1975;8(5):301–306.