Rocchi Lorenzo, Merendi Gianfranco, Mingarelli Luigi, Fanfani Francesco
Institute of Orthopedics, Catholic University of the Sacred Heart of Rome, Roma, Italy.
Tech Hand Up Extrem Surg. 2018 Sep;22(3):104-109. doi: 10.1097/BTH.0000000000000198.
The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible.
Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing.
Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction.
Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.
我们研究的目的是评估顺行性经皮髓内克氏针（K 针）固定治疗大量不稳定移位掌骨骨折的结果，以支持在尽可能多的骨折类型中使用这种微创技术。
自 2013 年 1 月起，每例符合纳入标准的患者均接受闭合复位和顺行性髓内 1 根或 2 根 K 针固定治疗。截至 2016 年 2 月，共评估了 150 例患者的 165 处掌骨骨折。平均随访时间为 10 周。通过手指总主动活动度、旋转畸形的存在、手臂、肩部和手部快速残疾评定量表（Q-DASH）评分以及患者自评手腕/手部评估（PRWHE）评分来评估临床结果。通过评估掌骨的背侧成角和缩短情况，比较术后 X 线片与显示骨折愈合的首张 X 线片，来评估影像学结果。
比较术后 10 周受伤手指与对侧手指的平均总主动活动度，未发现统计学差异。没有患者出现伸肌腱激惹，因此从未需要进行肌腱松解术。手臂、肩部和手部快速残疾评定量表的平均评分为 12.3（范围为 0 至 37）。患者自评手腕/手部评估的平均评分为 19（范围为 0 至 41）。骨折均稳定愈合。影像学评估显示术后复位丢失不明显。
顺行性髓内 K 针固定技术有效、可重复、成本低，非常适合治疗需要手术的掌骨骨折，可为多种骨折提供即时活动能力和良好的治疗效果。
