Plate versus Kirschner wire fixation in treatment of fourth and fifth carpometacarpal fracture-dislocations: A retrospective cohort study

BACKGROUND: Fourth and fifth carpometacarpal fracture-dislocations with unsatisfactory closed reduction commonly require later open reduction and internal fixation. However, the optimal method of internal fixation for these is unknown. The purpose of this study was to determine through objective clinical measures which method is superior for fourth and fifth carpometacarpal fracture-dislocations: a K-wire or a plate.

METHODS: We conducted a retrospective review of hospital records of patients who had received treatment for fourth and fifth carpometacarpal fracture-dislocations at one hospital between May 2007 and May 2015. A total of 86 patients who had received open reduction either with plate or K-wire fixation were included. Demographic and clinical characteristics of the two groups of patients were collected. Patients received standardised clinical tests one year after fixation. Clinical outcomes included tests of grip strength and scores on the Michigan Hand Outcomes Questionnaire and Disabilities of Arm, Shoulder, and Hand. Student's t tests and Chi-square tests were used to statistically evaluate whether plate or K-wire fixation was superior on the clinical variables.

RESULTS: The two groups were statistically indistinguishable on their demographic and clinical characteristics. Generally, the clinical outcomes of internal fixation were satisfactory. The average DASH and MHQ scores of the K-wire group were superior to those of the plate group (DASH 2.3 versus 9.8, P = 0.01; MHQ 96.7 versus 86.6, P = 0.02). Grip strength was not significantly different between the two groups (89.5 ± 5.8% versus 90.1 ± 4.9%, P = 0.36).

CONCLUSIONS: This non-randomly controlled, retrospective study suggests that clinical outcomes after K-wire fixation is superior to plate fixation for fourth and fifth carpometacarpal fracture-dislocations. This is especially the case for hand functions related to work. The present results suggest that K-wire fixation is the gold-standard technique for the treatment of fourth and fifth CMC fracture-dislocations.