[Osteosynthesis using perpendicular pins in the treatment of fractures and malunions of the neck of the 5th metacarpal bone].

At the same time as the paper by P. Vives in July 1981, we proposed, in June 1981, a fixation technique with two perpendicular K-wires for correction of rotated malunions of fractures of the neck of the fifth metacarpal. Longitudinal rotation of the distal fragment, either in pronation or in supination, interferes with thumb-little finger opposition and grip. It cannot always be corrected by orthopaedic reduction and osteosynthesis is sometimes necessary: an intramedullary axial K-wire with a curved tip maintains the proximal fragment and reduces its angulation in flexion. A transverse K-wire, perpendicular to the previous K-wire, through the head of the fifth metacarpal and into the head of the fourth metacarpal, maintains the reduction after very easily reducing the malrotation by flexing the ring finger together with the little finger. This method of fixation, allowing immediate rehabilitation, was used for osteosynthesis of fresh fractures, when indicated, and in the fixation of osteotomies of rotated malunions. Clinical consolidation was obtained within six weeks and the K-wires can be removed after radiological consolidation, after three months. We performed this technique in seven cases: four fractures and three malunions. There were no septic complications or injuries to cutaneous nerve branches. However, one K-wire was expelled and one repeat fracture was successfully treated by the same technique. The preferential indications in fractures are aesthetic and especially functional for certain manual occupations. The fixation is more precise and more solid than multiple K-wires and the results are regularly good or excellent allowing early recovery.