Intramedullary K-wire osteosynthesis of a subcapital fracture of the fifth metacarpal

Anatomy Perioperative management Technique Complications Evidence Total Video

Planning/Incision

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The entry point is dorsoulnar at the base of the metacarpus, without damaging the carpometacarpal joint and the insertion of the ECU tendon. Position control with the image intensifier. Then a stab incision is made and the cortex is exposed.
Preparing the K-wire

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A K-wire with a diameter of 2 mm is used. To reduce the risk of perforation of the thin cortical bone of the metacarpal head, it is introduced with the blunt tip. Prior to this, the distal blunt tip is bent upwards by about 20 degrees with pliers. For better handling, the proximal end of the wire is bent 90 degrees in the same plane. This allows better control of the direction of insertion.
Opening of the medullary cavity

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The cortex is opened with an awl under fluoroscopic guidance.
Insertion of the K-wire

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The wire is inserted into the medullary cavity and advanced in the diaphysis, if necessary with the aid of a hammer, until the tip is positioned directly in front of the fracture gap. The curved tip should point in a palmar direction.