Ahmet EKİN, Ahmet Cemil TURAN, Çağdaş BİÇEN, Mehmet Aykut TÜRKEN, Mehmet AKDEMİR, Abdullah Meriç ÜNAL

Metakarp Kırıklarının Metokarpofalangeal Eklemden Girilmeden Retrograd İntramedüller K Telleri ile tedavisi: Yeni ve Pratik Bir Teknik

GİRİŞ ve AMAÇ: İntramedüller K telleri ile tedavi edilenmetakarp kırıklarının sonuçlarını değerlendirmek içinretrospektif bir çalışma yaptık. Metakarp kırıklarının K-telleriile tedavisinde çeşitli cerrahi teknikler uygulanmaktadır.Hastalar, metakarpofalangeal eklem korunarak, kırıkhattından retrograd uygulanan intramedüller K telleri ileameliyat edildiler. YÖNTEM ve GEREÇLER: Çalışmamızda retro-antegradintramedüller K telleri ile tedavi ettiğimiz 44 hastanınfonksiyonel ve radyolojik sonuçlarını değerlendirmeyiamaçladık. Hastalar, metakarpofalangeal eklemdengirilmeden, kırık hattından ilerletilen 2 adet intramedüller K teli ile opere edildiler. Klinik sonuçları değerlendirmek için Q DASH skorlaması kullanıldı. Hastların;opere edilen ve sağlam5. metakarplarının son takip kontrolünde ölçülen lateralaçılanmalarının istatistiksel farkı karşılaştırıldı. İstatistikselanalizler Bağımlı Örneklem t-Testi ile yapıldı. BULGULAR: Tüm hastalarda kaynama elde edildi. Hastalarınklinik Q-DASH skoru ortalama 1.32 (+/- 2.466) idi. Hastaların ortalama 5. metakarp açılanmaları ameliyat öncesi 57.20 (+/- 11.12), sonrasında ise 2.67 (+/- 3.92) dereceydi. Tedavisonundaki en son kontrolde ortalama 5. Metakarpofalangealeklem hareket açıklığı sağlam elde 88.82 (+/- 1.317), opereedilen elde ise 88.84 (+/- 1.328) dereceydi. 2 hastada 8-12haftada gerileyen refleks sempatik distrofi gelişti. Preoperatifve postoperatif 5. metakarp lateral açılanma dereceleriarasında istatiksel olarak anlamlı fark olduğu görüldü(p:0.000, p0.05). TARTIŞMA ve SONUÇ: Tanımladığımız yöntem metakarpkırıklarında; distal kırık parçanın zarar görmemesi, ekstansörmekanizmanın korunması ve iyi klinik sonuçlar ile tercihedilecebilecek bir yöntemdir.

Treatment of Metacarpal Fractures with RetrogradeIntramedullary K Wires without Metacarpophalyngeal Joint Entry:A Novel and Practical Technique

INTRODUCTION: We performed a retrospective study toassess the outcomes of metacarpal fractures treated withintramedullary K-wires. Various surgical techniques weredescribed in treatment of metacarpal fracture with K-wires.The patients were operated with retrograde intramedullary K wires preserving metacarpophalyngeal joint by entering fromfracture site. METHODS: In our study we aimed to considerate functionaland radiological outcomes of 44 patients whom we treated withretro-ante-grade intramedullary K-wires. Patients wereoperated with 2 intramedullary K-wires forwarded fromfracture site without metacarpophalangeal entry. Q-DASHscore was used for evaluating clinical outcomes. Statisticaldifference between lateral angulations of operated andcontrlateral 5. metacarps at the last control were compared.Statistical analyses were performed with Paired Sample T test. RESULTS: Union was achieved among all patients. Meanclinical Q-DASH score of the patients was 1.32 (+/- 2.466).Mean lateral angulation of 5. metacarps were 57.20 (+/- 11.12) degrees before and 2.67 (+/- 3.92) postoperatively. Atlast control, mean Range of Motion of 5. Metacarpophalangealjoint was 88.82 (+/- 1.317) degrees on healty and 88.84 (+/- 1.328) degrees on operated hands. 2 patients suffered fromreflex sympathetic dystrophy, which regressed in 8-12th weeks.Preoperative and postoperative lateral angulation of 5.metacarps showed statistically significant difference(p: 0.000,p0.05). DISCUSSION AND CONCLUSION: The method wedescribed could be chosen in metacarpal fractures withadvantages such as; elimination of damage to the fractureddistal metacarpal piece, preserving extensor mechanism andhaving good functional outcomes.

PDF

___

1-Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908– 915. doi:10.1053/jhsu.2001.26322
2-de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. 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-Jones AR. A custom brace for treatment of angulated fifth metacarpal fractures. J Hand Surg Am. 1996;21(2):319–320. doi:10.1016/S0363- 5023(96)80132-8
4-Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br. 2006; 31(1): 61–65. doi:10.1016/j. jhsb.2005.06.022
5-Rhee SH, Lee SK, Lee SL, Kim J, Baek GH, Lee YH. Prospective multicenter trial of modified retrograde percutaneous intramedullary Kirschner wire fixation for displaced metacarpal neck and shaft fractures. Plast Reconstr Surg. 2012;129:694– 703.DOI:10.1097/PRS.0b013e3182402e6a
6-Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015; 473(5): 1747–1754. doi:10.1007/s11999-014-4079-7
7-Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?. Orthop Traumatol Surg Res. 2010; 96(5): 506–512. doi:10.1016/j.otsr.2010.02.009
8- Greeven AP, Bezstarosit S, Krijnen P, Schipper IB. Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review. Eur J Tauma Emerg Surg. 2016; 42: 169-75. DOI:10.1007/s00068-015-0507-y
9-Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995; 20(3 Pt 2): S86–S90. doi:10.1016/s0363-5023(95)80176-6
10- Sletten IN, Nordsletten L, Husby T, Ødegaard RA, Hellund JC, Kvernmo HD. Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. J Hand Surg Eur Vol. 2012; 37(5): 387– 395. doi:10.1177/1753193411431048
11- Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin. 2006; 22(3): 287– 295. doi:10.1016/j.hcl.2006.02.018
12- Ozer K, Gillani S, Williams A, Peterson SL, Morgan S. Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures. J Hand Surg Am. 2008; 33(10): 1724–1731. doi:10.1016/j.jhsa.2008.07.011
13- Fusetti C, Meyer H, Borisch N, Stern R, Santa DD, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma. 2002; 52(3):535–539. doi:10.1097/00005373-200203000- 00019
14- Botte MJ, Davis JL, Rose BA, et al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res. 1992;(276):194–201.
15-Moon SJ, Yang JW, Roh SY, Lee DC, Kim JS. Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone. Arch Plast Surg. 2014;41:768-72.
16- Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma. 2003; 55(3): 509–513. doi:10.1097/01.TA.0000029368.40479.A2
17- Potenza V, Caterini R, De Maio F, Bisicchia S, Farsetti P. Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning. Injury. 2012;43(2):242–245. doi:10.1016/j.injury.2011.10.036
18- Lee SK, Kim KJ, Choy WS. Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures. Eur J Orthop Surg Traumatol. 2013; 23(5): 535–543. doi:10.1007/s00590-012-1036-6
19- Gonzalez MH, Igram CM, Hall RF Jr. Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am. 1995; 20(3): 382–387. doi:10.1016/S0363-5023(05)80091-7
20- Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br. 1999; 24(1): 76–79. doi:10.1016/s0266-7681(99)90039-6
21- Hiatt SV, Begonia MT, Thiagarajan G, Hutchison RL. Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures. J Hand Surg Am. 2015; 40(8): 1586–1590. doi:10.1016/j.jhsa.2015.03.035