gms | German Medical Science

Objectives/Interrogation: We evaluated the outcomes of a percutaneous corrective osteotomy technique stabilised with K-wires.

Technique: The osteotomy is performed by passing multiple 1.1mm K-wires across the bone and then closed manipulation to create a low energy fracture. Once the alignment is corrected, it is held with one or more K-wires supported with a plaster cast for five to six weeks.

Review: We retrospectively reviewed the 21 patients who had a percutaneous corrective osteotomy operated between 2003 and 2014. The mean time from injury to osteotomy was 29 (range: 3-105) months. There were 17 women and 4 men with a mean age at surgery of 30 (range: 11-84) years. Of the 19 phalangeal malunions, 2 had a combined angulation and rotational deformity, 11 had an angulation deformity and 6 a rotational deformity. There were 2 metacarpal malunions, 1 with an angulation deformity and 1 a rotational deformity. The long-term subjective outcome was assessed using QuickDASH, Michigan Hand Outcome and Patient and Observer Scar Assessment Scale (POSAS) Questionnaires at a mean of 96 (range: 5-149) months post-surgery. The long-term objective outcome was assessed by measuring ranges of motion and grip strength at a mean of 63 (range: 2-140) months post-surgery.

Results and Conclusions: Full correction of the pre-operative deformity was achieved in 17 patients (81%), with full correction of all the rotational components. All osteotomies had united. Other than 1 patient with dystrophy, resolving within 3 months, no intra-operative or post-operative complication occurred. The mean QuickDASH score was 20.7 and Michigan Hand Outcome score was 78.7. The PSOAS patient scale total score was 8.4, with an overall opinion of the scar score of 2. The mean ranges of motion, compared to the contralateral uninjured side, were 100% at the MCP joints and 89% at the PIP joints. Grip strength measurements of the operated side averaged 70% of those in the uninjured hand.

Conclusion: Percutaneous osteotomy is an effective and reproducible technique to correct post-traumatic metacarpal and phalangeal malunions, particularly metaphyseal and rotational deformities, with a low complication rate.