Biomechanical Comparison of 2 Methods of Intramedullary K-Wire Fixation of Transverse Metacarpal Shaft Fractures.

Purpose To determine the relative importance of intramedullary wire (IMW) diameter and IMW number in conferring stability to a metacarpal fracture fixation construct. Our research hypothesis was that the stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter (0.062-in) wire would be greater than three 0.8-mm-diameter (0.031-in) wires. Methods Our study compared the biomechanical stiffness between one 1.6-mm K-wire and three 0.8-mm K-wires in a composite, fourth-generation, biomechanical metacarpal construct under cantilever testing to treat transverse metacarpal shaft fractures. Six composite bone-wire constructs were tested in each group using constant-rate, nondestructive testing. Stiffness (load/displacement) was measured for each construct. Results All constructs demonstrated a linear load-displacement relationship. Wires were all tested in their elastic zone. The mean stiffness of the 1-wire construct was 3.20 N/mm and the mean stiffness of the 3-wire construct was 0.76 N/mm. These differences were statistically significant with a large effect size. Conclusions The stiffness of IMW fixation for metacarpal shaft fractures using a single 1.6-mm-diameter wire was significantly greater than using three 0.8-mm-diameter wires. Clinical relevance When IMW fixation is clinically indicated for the treatment of metacarpal fractures, the increased stiffness of a single large-diameter construct provides more stability in the plane of finger flexion-extension.