A Minimally Invasive Technique for Correcting Extra-Articular Malunions of Metacarpal Fractures

Purpose This study aimed to introduce a minimally invasive technique for correcting malunions of extra-articular metacarpal fractures followed by percutaneous fixation with a cemented K-wire frame. Methods From January 2018 to January 2022, 31 patients (31 malunions of extra-articular metacarpal fractures) were treated. The mean age of the patients was 32 years (range, 21–52 years). There were 25 fifth, 4 fourth, 1 third, and 1 second metacarpal malunions. The range of motion of the finger was assessed based on the total active motion scoring system of American Society for Surgery of the Hand. The motion was graded as excellent (85–100%), good (70–84%), fair (50–69%), and poor (below 50% based on a comparison of the opposite finger. The aesthetic appearance of the hand was evaluated based on the 10-cm visual analogue scale. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS; 0–10, very dissatisfied; 11–18, dissatisfied; 19–26, satisfied; 27–28, very satisfied). Results Bone healing was achieved in all patients after a mean of 5.4 weeks (range, 4–10 weeks). The mean follow-up period was 27 months (range, 24–33 months). The mean preoperative TAM scale was 233° (range, 185°–288°), and the postoperative scale was 263° (range, 235°–290°). There were 8 excellent, 19 good, and 1 fair result. There were 15 very satisfied and 13 satisfied results. The mean preoperative aesthetic appearance of the hand was 7 cm (range, 5 cm – 8 cm), and the postoperative appearance was 10 cm (range, 9 cm – 10 cm). Conclusion The minimally invasive technique is effective for correcting extra-articular malunions of metacarpal fractures. The rigid fixation allows fracture healing and early motion of the injured hand. The technique improves hand function, patient satisfaction, and the aesthetic appearance of the hand. Level of Evidence Therapeutic study, Level IVa.