PROCEDURE 12

Closed Reduction with Kirschner Wire (K-wire)

Fixation of Metacarpal Neck and Shaft Fractures
Taichi Saito and Steven C. Haase

Indications
• Note: Most metacarpal fractures do not require operative treatment. Nondisplaced
fractures and displaced fractures that are stable after reduction may be treated non-
operatively.
• Surgery may be indicated for fractures that have recurrent or residual displacement
after an attempt at reduction, especially if the fracture displacement results in distur-
bance in form or function of the hand.
• Specific indications for surgery include:
• Rotational deformity (Fig. 12.1): Even small amounts of rotational deformity (10
degrees) can cause overlap (“scissoring”) of the digits; therefore, this deformity
must be corrected to preserve proper hand function.
• Angular deformity (typically apex-dorsal) (Fig. 12.2):
• Due to compensatory motion at the carpometacarpal (CMC) joints, residual an-
gulation of metacarpal fractures is tolerated better in the thumb, ring, and small
fingers than in the index and middle digits.
• In particular, the small finger metacarpal neck fracture (often called a “boxer’s
fracture”) is a common fracture that typically heals with negligible morbidity, de-
spite significant residual angulation, as long as there is no rotational deformity.
• Surgical correction should be considered for shaft angulation of:
• Index and middle >5 to 10 degrees
• Ring >20 degrees
• Small >30 degrees
• Thumb >30 degrees
• Surgical correction should be considered for neck angulation of:
• Index and middle >10 to 15 degrees
• Ring >20 to 30 degrees
• Small >40 to 70 degrees (wide variation in recommendations)

Dorsal
Angular deformity

Rotational Volar
deformity

Fig. 12.1 Fig. 12.2

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