HAND/PERIPHERAL NERVE Prospective Multicenter Trial of Modified Retrograde Percutaneous Intramedullary Kirschner Wire Fixation for Displaced Metacarpal Neck and Shaft Fractures Seung Hwan Rhee, M.D. Sang Ki Lee, M.D. Sang Lim Lee, M.D. Jihyeung Kim, M.D. Goo Hyun Baek, M.D. Young Ho Lee, M.D. Seoul and Daejeon, South Korea Background: The purpose of this prospective multicenter study was to assess the clinical and radiographic outcome of a newly devised technique of retrograde intramedullary fixation with multiple Kirschner wires in metacarpal neck and shaft fractures. Methods: Between May of 2002 and June of 2007, a total of 121 metacarpal fractures in 105 patients that were treated with the authors’ modified intramed- ullary Kirschner wire fixation technique were included in this study. The average follow-up period was 10 months. The surgical outcome was assessed by clinical and radiographic data. Results: The average range of motion in the metacarpophalangeal joint of the injured side was not significantly different from that of the uninjured side. There was no case of residual rotational deformity postoperatively, and the average Disabilities of the Arm, Shoulder and Hand questionnaire score was 8.5 (range, 0 to 41). Average dorsal apex angulation and average shortening were reduced significantly from 39.0 degrees and 3.1 mm, to 9.7 degrees and 0.0 mm, re- spectively, in neck fractures; and from 29.5 degrees and 3.0 mm, to 7.0 degrees and – 0.1 mm in shaft fractures, respectively. Average time to union was 5.6 weeks, and there were no cases of nonunion. Conclusion: Modified retrograde intramedullary fixation with multiple Kirsch- ner wires is a straightforward and reliable technique that successfully resulted in good functional and cosmetic results in addition to excellent bone healing. (Plast. Reconstr. Surg. 129: 694, 2012.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. M etacarpal fractures are among the most common injuries to the hand, accounting for approximately one-third of hand fractures. 1–4 Although the majority of these frac- tures can be successfully treated conservatively, in some cases, in which deformities such as dorsal apex angulation, shortening, and malrotation are present, surgical correction may be preferred to prevent significant malunion causing poor cos- metic or functional outcome. Unstable, displaced fractures of metacarpal bones can be treated sur- gically with various techniques, including percu- taneous wire fixation, external fixation, lag screw fixation, and plate and screw fixation. Among them, percutaneous wire fixation techniques have been advocated to afford considerable stability and to avoid the potential complications of open surgery. Since Lord introduced intramedullary fixa- tion of displaced metacarpal fractures in 1957 5 and Foucher et al. reported a “bouquet” tech- nique of antegrade nailing using multiple Kirsch- ner wires in 1975, 6 various wire fixation techniques that had a different aspect of entry point, number of wires, location of wire end, postoperative immo- From the Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center; Inje University Sanggye-Paik Hos- pital; and Eulji University Hospital. Received for publication July 29, 2011; accepted September 26, 2011. Copyright ©2012 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e3182402e6a Disclosure: The authors have no financial interest to declare in relation to the content of this article. www.PRSJournal.com 694