Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review

European Journal of Trauma and Emergency Surgery, Mar 2015

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 meta-analyses 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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00068-015-0507-y.pdf

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 - 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)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00068-015-0507-y.pdf

A. P. A. Greeven, S. Bezstarosti, P. Krijnen, I. B. Schipper. Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review, European Journal of Trauma and Emergency Surgery, 2016, pp. 169-175, Volume 42, Issue 2, DOI: 10.1007/s00068-015-0507-y