중수골 기저부 및 경부 골절에서 K-강선을 이용하여 만든 Staple 고정술의 치료 결과 = Clinical Outcomes of Customized Staple Fixation Using K-wire in Metacarpal Base or Neck Fractures

국문 초록 (Abstract)

목적: 중수골 기저부 및 경부 골절의 치료에서 K-강선 staple 고정술의 방사선학적 및 임상적 결과를 알아보고자 하였다.
대상 및 방법: 2016년 11월부터 2017년 5월까지 도수정복이 제한되는 중수골 기저부 및 경부의 불안정 골절을 최소절개를 통한 개방적 정복 후 K-강선 staple로 고정한 13예(10명)의 방사선학적 및 임상적 결과를 후향적으로 분석하였다.
결과: 각 골절에 평균 2.6개의 staple로 고정하였고 각형성은 술 전 36.3도에서 술 후 3.1도로 교정되었다. 술 후 1주에 능동관절운동을 시작한 뒤 방사선학적 골유합은 5.1주에 확인하였고 7.4주에 정상운동범위를 회복하였다. Staple은 16.5주에 제거하였고 치료기간은 18.6주 소요되었다. 최종 추시(27.3주)에서 운동범위와 파악력은 건측과 차이 없이 회복되었다. 변형, 신경손상, 감염 등의 합병증 없이 전 예에서 골유합을 관찰하였고 환자평가에서 외관과 기능상 모두 만족할 만한 결과를 얻을 수 있었다.
결론: 중 수골 기저부 및 경부의 불안정 골절에서 K-강선 staple을 이용한 고정술은 최소 절개와 견고한 내고정을 통해 조기 관절운동이 가능하며 수술 후 관절 강직을 방지하고 치료기간을 줄일 수 있는 효과적인 치료방법으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: This study was designed to evaluate the radiological and clinical outcomes of a new surgical technique―customized staple fixation using K-wire―in displaced metacarpal neck or base fractures.
Materials and Methods: From November 2016 to May 2017, 13 unstable metacarpal neck and base fractures (10 patients) were treated with II-shaped customized K-wire staples fixation, after performing open reductions through minimal dorsal incisions. The radiological and clinical outcomes were retrospectively evaluated.
Results: A mean of 2.6 staples were used for each fracture fixation. Preoperative angulation of 36.3° was reduced to 3.1° postoperatively. A week after surgery, the volar short arm splint was replaced with a dorsal splint to initiate active range of motion exercise, and the splint was subsequently removed after 3 weeks. The radiologic union was achieved at a mean of 5.1 weeks, and total active motion was recovered at a mean of 7.4 weeks. On a mean, K-wire staples were removed at 16.5 weeks after the surgery, and the mean treatment took 18.6 weeks. At the final follow-up (at mean 27.3 weeks), no significant difference was observed for total active motion of the digits and grip strength, when compared to the contralateral hand. Complete union was achieved in all fractures without deformity, or complications such as infection or nerve injury. All patients were satisfied with the cosmetic and functional outcomes.
Conclusion: K-wire stapling is an effective alternative modality in treating unstable displaced metacarpal neck or base fractures. It requires minimal incision to enable open reduction. In addition, early mobilization is ensured through the rigid fixations. Moreover, it prevents postoperative joint stiffness and reduces the time needed for treatment.

참고문헌 (Reference)

1 김태형, "제5 중수골 경부 골절에서 미리 구부려진 K-강선을 이용한 전향적 골수강내 고정술" 대한골절학회 24 (24): 67-72, 2011

2 Choi SJ, "Treatment method of the metacarpal bone fractures with retrograde percutaneous intramedullary K-wire fixation to decrease the injury of extensor tendon" 9 : 117-122, 2004

3 Ali A, "The biomechanical effects of angulated boxer’s fractures" 24 : 835-844, 1999

4 Harris AR, "Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization" 4 : 161-164, 2009

5 Padegimas EM, "Metacarpal neck fractures: a review of surgical indications and techniques" 5 : e32933-, 2016

6 Weinstein LP, "Metacarpal fractures" 2 : 168-180, 2002

7 Freeland AE, "Mechanical properties of 3M staples in bone block models" 15 : 727-731, 1992

8 Hargreaves DG, "Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires" 29 : 374-376, 2004

9 Feehan LM, "Is there evidence for early mobilization following an extraarticular hand fracture?" 17 : 300-308, 2004

10 Nakashian MN, "Incidence of metacarpal fractures in the US population" 7 : 426-430, 2012

11 Jahss SA, "Fractures of the metacarpals: a new method of reduction and immobilization" 20 : 178-186, 1938

12 Paul AS, "Fixation of closed metacarpal shaft fractures. Transverse K-wires in 22 cases" 65 : 427-429, 1994

13 Facca S, "Fifth metacarpal neck fracture fixation: locking plate versus Kwire?" 96 : 506-512, 2010

14 Feehan LM, "Early controlled mobilization of potentially unstable extra-articular hand fractures" 16 : 161-170, 2003

15 Diaz-Garcia R, "Current management of metacarpal fractures" 29 : 507-518, 2013

16 Markiewitz AD, "Complications of hand fractures and their prevention" 29 : 601-620, 2013

17 Page SM, "Complications and range of motion following plate fixation of metacarpal and phalangeal fractures" 23 : 827-832, 1998

18 Kwon GD, "Biomechanical study of fixation methods for comminuted phalangeal fractures" 11 : 221-226, 2006

19 Hoon QJ, "Biomechanical evaluation of shape-memory alloy staples for internal fixation-an in vitro study" 3 : 19-, 2016

20 Low CK, "A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers" 20 : 609-613, 1995