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Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique

CATEGORY: Trauma; Midfoot/Forefoot INTRODUCTION/PURPOSE: The antegrade intramedullary nailing technique with Kirchner’s wire (K-wire) (EAK) for the management of metatarsal fractures (MTT) is recent and with few reports. Our objective was to evaluate and compare the clinical results among patients o...

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Autores principales: Drago, Sebastian R., Zagal Alvarado, Patricio Alfonso, Ugarte, Jaime, Phillips, Vicente, Contreras, Martin, Bastias, Gonzalo F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793558/
http://dx.doi.org/10.1177/2473011421S00181
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author Drago, Sebastian R.
Zagal Alvarado, Patricio Alfonso
Ugarte, Jaime
Phillips, Vicente
Contreras, Martin
Bastias, Gonzalo F.
author_facet Drago, Sebastian R.
Zagal Alvarado, Patricio Alfonso
Ugarte, Jaime
Phillips, Vicente
Contreras, Martin
Bastias, Gonzalo F.
author_sort Drago, Sebastian R.
collection PubMed
description CATEGORY: Trauma; Midfoot/Forefoot INTRODUCTION/PURPOSE: The antegrade intramedullary nailing technique with Kirchner’s wire (K-wire) (EAK) for the management of metatarsal fractures (MTT) is recent and with few reports. Our objective was to evaluate and compare the clinical results among patients operated on in our center for MTT fractures using the EAK technique versus the traditional retrograde technique (ERK). METHODS: Retrospective, analytical study. We reviewed the cases of patients with a diagnosis of MTT fracture and surgical indication operated with EAK or ERK between February 2010 and January 2016. First and fifth metatarsal fractures were excluded from the analysis, as well as patients in which a fixation method other than K-wire was used. Demographic data, clinical and radiological results were recorded. A total of 34 patients (34 feet, 70 metatarsals) were analyzed and were divided into two groups: Group 1, operated with EAK (15 feet, 22 metatarsals), and Group 2, operated with ERK (19 feet, 48 metatarsals). Statistical analysis was carried out with Fisher's exact test and Mann-Whitney U test for non-parametric variables, with fixed statistical significance at p <0.05. RESULTS: The median age was 37 years [IQR = 51-25.25], p = 0.128. Both groups presented similar soft tissue involvement (p = 1,000), similar associated injury rate (20.0% vs 42.1%, p = 0.271), and similar proportions of diaphyseal and neck fractures (p = 0.659 and p = 0.733 respectively). The group operated with the EAK technique presented a lower report of metatarsalgia (6.7% (1) vs 47.3% (9), p = 0.020), shorter rest time since injury (94 days [IQR = 129-82] vs 144 days [IQR = 210-122], p = 0.002) and shorter time to full load (7 weeks [IQR = 9-6] vs 10 weeks [IQR 12.5-8.5], p = 0.002). EAK and ERK did not show differences in criteria for poor reduction (p = 1.00), number of re-interventions (p = 0.560), infections (p = 0.492), or metatarsophalangeal stiffness (p = 0.451). CONCLUSION: Metatarsal fracture fixation with EAK presented a lower rate of metatarsalgia and shorter rest time compared to ERK, demonstrating similarity in terms of quality of reduction and complication rate.
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spelling pubmed-87935582022-01-28 Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique Drago, Sebastian R. Zagal Alvarado, Patricio Alfonso Ugarte, Jaime Phillips, Vicente Contreras, Martin Bastias, Gonzalo F. Foot Ankle Orthop Article CATEGORY: Trauma; Midfoot/Forefoot INTRODUCTION/PURPOSE: The antegrade intramedullary nailing technique with Kirchner’s wire (K-wire) (EAK) for the management of metatarsal fractures (MTT) is recent and with few reports. Our objective was to evaluate and compare the clinical results among patients operated on in our center for MTT fractures using the EAK technique versus the traditional retrograde technique (ERK). METHODS: Retrospective, analytical study. We reviewed the cases of patients with a diagnosis of MTT fracture and surgical indication operated with EAK or ERK between February 2010 and January 2016. First and fifth metatarsal fractures were excluded from the analysis, as well as patients in which a fixation method other than K-wire was used. Demographic data, clinical and radiological results were recorded. A total of 34 patients (34 feet, 70 metatarsals) were analyzed and were divided into two groups: Group 1, operated with EAK (15 feet, 22 metatarsals), and Group 2, operated with ERK (19 feet, 48 metatarsals). Statistical analysis was carried out with Fisher's exact test and Mann-Whitney U test for non-parametric variables, with fixed statistical significance at p <0.05. RESULTS: The median age was 37 years [IQR = 51-25.25], p = 0.128. Both groups presented similar soft tissue involvement (p = 1,000), similar associated injury rate (20.0% vs 42.1%, p = 0.271), and similar proportions of diaphyseal and neck fractures (p = 0.659 and p = 0.733 respectively). The group operated with the EAK technique presented a lower report of metatarsalgia (6.7% (1) vs 47.3% (9), p = 0.020), shorter rest time since injury (94 days [IQR = 129-82] vs 144 days [IQR = 210-122], p = 0.002) and shorter time to full load (7 weeks [IQR = 9-6] vs 10 weeks [IQR 12.5-8.5], p = 0.002). EAK and ERK did not show differences in criteria for poor reduction (p = 1.00), number of re-interventions (p = 0.560), infections (p = 0.492), or metatarsophalangeal stiffness (p = 0.451). CONCLUSION: Metatarsal fracture fixation with EAK presented a lower rate of metatarsalgia and shorter rest time compared to ERK, demonstrating similarity in terms of quality of reduction and complication rate. SAGE Publications 2022-01-21 /pmc/articles/PMC8793558/ http://dx.doi.org/10.1177/2473011421S00181 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Drago, Sebastian R.
Zagal Alvarado, Patricio Alfonso
Ugarte, Jaime
Phillips, Vicente
Contreras, Martin
Bastias, Gonzalo F.
Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title_full Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title_fullStr Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title_full_unstemmed Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title_short Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
title_sort percutaneous fixation of metatarsals fractures with kirchner’s wire, comparison of antegrade and retrograde technique
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793558/
http://dx.doi.org/10.1177/2473011421S00181
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