Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review
Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review
A. P. A. Greeven 0 1
S. Bezstarosti 0 1
P. Krijnen 0 1
I. B. Schipper 0 1
0 Department of Surgery, HagaHospital , The Hague , The Netherlands
1 Department of Trauma Surgery, Leiden University Medical Centre , Leiden , The Netherlands
Purpose Open reduction and internal fixation (ORIF) of single, closed metacarpal shaft fractures is increasingly preferred over closed reduction and percutaneous fixation (K-wire). The aim of this systematic review is to determine whether the preference for ORIF can be substantiated based on the available literature regarding the functional outcome and complications after surgery. Methods A systematic review was performed using a computer-based search on MedLine and Embase, following the preferred reporting items for systematic and metaanalyses guidelines. Results Five non-comparative studies were found. Two studies reported on 36 ORIF-treated patients. Three studies reported on 65 K-wire-treated patients. Complications were reported in 8 ORIF-treated patients (22 %) and in 23 K-wire-treated patients (35 %). Functional outcome was generally reported as good for both techniques. Nonetheless functional impairment requiring reoperation was reported in 6 ORIF-treated patients (17 %) and in none of the K-wire-treated patients. Conclusions Although for both techniques good functional outcomes were reported, the significance of the functional impairment after ORIF requiring reoperation suggests ORIF to be a less favorable technique for single, closed metacarpal shaft fractures.
Closed metacarpal fracture; Single shaft fracture; Operative treatment; Open reduction and internal fixation; Percutaneous fixation; Kirschner wire
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Metacarpal fractures are among the most common
fractures of the skeletal system and account for 36 % of hand
and wrist fractures [2, 9, 14, 15]. The peak incidence of
metacarpal shaft fractures is between 20 and 40 years and
results in significant societal costs [11]. The majority of
metacarpal shaft fractures can be treated conservatively
[14]. Numerous indications for operative treatment include
malrotation, angulation, longitudinally shortening, multiple
fractures and fractures with associated soft tissue injuries
or bone loss [2, 3, 7, 8, 14, 18, 20]. With the introduction
of new fixation techniques for metacarpal fractures in the
last 25 years, open reduction and internal fixation (ORIF)
gained increasing popularity, because stable ORIF fixation
allows early mobilization [6, 19]. The reasons for surgeons
to decide for open reduction and internal fixation also
included the improvement of materials and instruments,
better understanding of biomechanical principles of
internal fixation, and the availability of antibiotics to reduce
infection. A well-known alternative surgical treatment
options is closed reduction and percutaneous fixation with
Kirschner wires (K-wires) [3, 14].
This systematic review was performed to determine
the functional outcome and postoperative complication
for both these surgical techniques in the treatment of
single, closed metacarpal shaft fractures. This review aims to
determine whether the preference for ORIF can be
substantiated based on available data in the literature in terms of
functional outcome and complications.
A systematic review was performed following the
Preferred Reporting Items for Systematic Reviews and
MetaAnalyses guidelines, including (1) a systematic search of
the literature, (2) selection of studies, (3) recording of study
characteristics, (4) assessment of methodological quality of
studies, and (5) extraction and comparison of clinical
outcomes [10].
Search strategy
The literature search was conducted in both MedLine and
Embase on September 12th 2014. The search strategies
were developed by a trained medical librarian and included
combinations of different terms and synonyms for
extraarticular metacarpal fractures and surgical treatment. The
detailed search strategies are described in the Appendix.
Selection of studies
After removal of duplicate studies from the MedLine and
Embase literature searches, the title and abstract of the
remaining studies were screened to evaluate if they met
the following criteria: (1) Language: English or German.
(2) Study design: comparative (randomized or
non-randomized), prospective or retrospective studies. (3)
Population: Humans with a single shaft fracture located in the
second, third, fourth or fifth metacarpal. (4) Intervention:
ORIF and/or percutaneous transverse K-wires. (5)
Outcome: hand function, consolidation and/or complications.
Of the selected abstracts, the full-text articles were
screened using the same inclusion criteria. The reference
lists of selected articles were screened for additional
relevant studies (Fig. 1).
Recording of study characteristics
The following study characterist (...truncated)