[Possibilities and limits of intramedullary Kirschner wire osteosynthesis in treatment of metacarpal fractures].

An alternative method for treating metacarpal fractures using intramedullary Kirschner-wire pinning is presented. This procedure does not immobilize the metacarpophalangeal joint, thus allowing early motion exercises of the affected hand which is of particular advantage in fractures of the metacarpal neck. Since May 1993, we have treated 33 patients with 37 fractures; the fifth metacarpal was involved in each case. An awl is used to prepare an opening in the cortex for insertion of two or three pre-bent K-wires which are then advanced distally from the base of the metacarpal bone. The hand is immobilized on a plaster splint for one week. Work load is increased after three weeks. With the exception of three cases, our patients achieved free movement of the fingers with anatomical alignment of the fracture site at the time of wire removal. Three cases were re-operated upon due to K-wire migration or fracture displacement. Ideal indications for this procedure are distal transverse and short oblique fractures.