Needle in the Bone: Spinal Stylets Outpace K-Wires for Faster Healing in Metacarpal Fractures
DOI:
https://doi.org/10.55489/ijmr.1303202585Keywords:
Metacarpal shaft fracture, Intramedullary nailing, Spinal needle stylet, K-wire fixation, Clinical union, Functional outcomeAbstract
Background: Metacarpal shaft fractures, comprising up to 40% of hand injuries, demand balanced fixation to optimize union and function. Traditional K-wire intramedullary nailing faces challenges like rotational instability and delayed mobilization. This study evaluates spinal needle stylets (18-20G) as an elastic alternative, hypothesizing superior clinical union and outcomes.
Methods: In this prospective randomized trial at a tertiary center, 92 adults (≥18 years) with closed/open (Gustilo-Anderson I/II) metacarpal shaft fractures were allocated 1:1 to retrograde intramedullary fixation using pre-bent spinal needle stylets or 1.5-2 mm K-wires. Primary outcomes were clinical (tenderness absence) and radiological union (trabecular alignment). Secondary measures included Brief Michigan Hand Questionnaire (MHQ) scores and range of motion (ROM) at 6 months. Complications were tracked. Analysis used t-tests, chi-square, and odds ratios (p<0.05 significant).
Results: Baseline demographics and fracture patterns were comparable (mean age 38.3 years; 87% male). Clinical union by 4 weeks was faster with stylets (76.1% vs. 43.5%; OR 4.14, 95% CI 1.69-10.11; p=0.003); radiological union by 6 weeks was similar (78.3% vs. 69.6%; p=0.476). Normalized MHQ scores favored stylets (72.5±11.6 vs. 67.5±12.3; p=0.048), with better wrist extension (51±11° vs. 45±10°; p=0.007) and MCP flexion trend (50±13° vs. 44±17°; p=0.060). Complications (infection 8.7-13.0%; stiffness 10.9-15.2%) were equivalent (p=0.463).
Conclusion: Spinal needle stylets accelerate clinical union and enhance functional recovery in metacarpal shaft fractures, offering a flexible, cost-effective option over K-wires. This approach merits broader adoption in resource-limited settings to minimize disability.
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