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

• Perforation of the cortex by wire or drill
• Lesion of the branches of the dorsal branch of the ulnar nerve
• Incomplete reduction of the fracture. Here, as a last resort, a semi-open reduction of the metacarpal head can be attempted by introducing a mini-Hohmann along the bone through a mini-incision ulnar to the head. The tip of the Hohmann can then be used as a lever to directly elevate the displaced head.

Acute Complications

• Bleeding/hematoma
• Infection/wound healing disorder
• Loosening of the K-wire
• Perforation of the K-wire through the cortex of the metacarpal head

Management

• In case of significant hematoma, surgical revision
• In case of infection, immediate surgical revision
• In case of K-wire loosening or perforation, consider early removal of metal

Late Complications

• Pseudarthrosis
• Prolonged scar pain/neuroma pain
• Restriction of movement
• CRPS (Sudeck's disease)

Management

• In case of corresponding symptomatology, revision
• In case of scar pain/neuroma pain/neuropathic pain, wait-and-see approach, if necessary, desensitization therapy
• In case of CRPS, appropriate treatment of the disease (see literature)