Osteosynthesis of Metacarpal and Phalangeal Fractures using Interlocked K-wire Technique Followed by Early Mobilization: A Pilot Study

Introduction: The use of k-wires is a well-established technique for fixation of metacarpal and phalangeal fractures. These are inexpensive, readily available, and can be inserted percutaneously. Despite the advantages, k-wire use has complications such as wire loosening and breakage and is usually supplemented by use of splints. Immobilization of the digits might lead to joint stiffness and pain. The study aims to see if interlocking the k-wires together with early mobilization will not lead to loss of fixation and had good outcomes.

Design: This is a descriptive study design. Purposive sampling was used within 12 months of data gathering. The samples include metacarpal and phalangeal fractures with no tendon or nerve involvement. Injuries requiring subsequent procedures, those with polytrauma and/or comorbidities were excluded into the study. The technique was interlocking the k-wires to each other forming a triangle, applying a volar splint for 48 hours, and early range of motion exercises for the affected and adjacent digits. 

Results: A total of 22 fractures were evaluated with a breakdown of 8 metacarpal, 11 proximal phalanx and 3 middle phalanx fractures. At 4th week post operatively, 21 fractures have a stable fixation; 1 had a loss of fixation as evidenced by wire loosening and backing out. At 12th week post operatively, 21 fractures achieved union. 1 had a non-union as evidenced by motion and pain at the fracture site; no fractures went into malunion; 4 reported pains at the joint near the fracture site with a mean score of 4.25/10 and these were observed to be intraarticular fractures. No pain was reported on the adjacent joints during range of motion. 

Conclusion: The interlocked K-wire technique is a stable configuration to permit early mobilization and its use might be only applicable to simple fracture configuration. A larger sample size, longer follow up period, and a comparator group are the recommendations for further research studies. 

Keywords: k-wire, fracture, fixation, metacarpal, phalanx, interlock