Intramedullary stabilization of sub-capital metacarpal fractures using Kirschner wire (k-wire) was introduced by Foucher [7,8]. After anesthesia (general/regional), painting and draping weredone and the fracture was reduced with k-wires under C-arm intensifier. P.O.P. cock-up/below elbowslab was applied after the surgeryAll patients were discharged the next day after the surgery after getting their postoperative x-rays. In our study, 12 cases were open fracture and 5 cases had associated injuries whose duration of stay was prolonged (mean duration was 4 days)

All patients were called for follow up at 15 days, 4^th week (k-wire was removed and repeat x-ray wasdone), third month and sixth month postoperatively Metacarpal joint function (flexion/extension) and rotatory displacement was clinically assessed during follow-up examinations. After a radiological demonstration of bone healing normally after 4 weeks, the k-wires were removed under local anesthesia in OPD. Physiotherapy (all movements) was done under the supervision of the treating doctor and physiotherapist and the patient was advised to do the same at home.

Most of the patients in our study were young male of the age group 20-30 years. There were 34 males (68%) and 16 females (32%) in our study. The dominant hand (right in all cases) was affected in about 56% (n=28) cases and the non-dominant hand (left hand in all cases) was affected in about 44%(n=22) cases.

The most common cause fell on hand (38%;n=19), followed by fight (assault ) in 12 cases, road traffic accident (RTA) in 08 cases, fall of the heavy object directly on the hand in 5 cases and other causes like hitting against any object like a wall, table etcwere seen in 6 cases. The most common fracture pattern was AO type B fracture (epiphyseal and metaphyseal) seen in 48% of cases. (n=24),there were 32 %(n=16) A type fractures and 20% (n=10)cases of type C fractures

After preoperative evaluation including an x-ray of the injured hand (AP and Oblique view), surgery was planned for patients having palmar dislocation of >30°,shortening of >5 mm. and cases with open fractures.

K-wires were removed after 4 weeks postoperatively, under local anaesthesia in the OPD.

None of the patients was found to have any pre-existing functional deficits. Preoperative X-rays were done of all patients to note down palmer dislocation and shortening.

In all patients, when compared with the normal opposite side, the hand functions was not found to be impaired.

Most of the times these metacarpal fractures can be treated conservatively in a POP slab(cock up slab) producing good functional results [7]. Surgery was indicated in patients with palmar dislocation of >30° and shortening of >5 mm. [7]. In 1939, Kuntscher et al. first described intramedullary [10]. Fixation of long bones [11,12]. In the study,it was found that intramedullary fixation decreased infection rates, shortened hospital stays, and allowed for rapid return to function.

Intra medullary fixation was first used for metacarpal fractures by a military surgeon, Lord [13]. In 1975, Foucher et al. [8]. Introduced the “bouquet” method in which he used to pass three Kirschner wires (K-wire) longitudinally into the medullary in a divergent fashion. Bouquet osteosynthesis gained popularity through Europe thereafter [7]. and since then many articles with different variations in techniques were published with good results [10,14,23]. Also various retrospective and case series studies with good results are published in favour of intramedullary fixation of metacarpal fractures[10,13,17,22,24].

This technique of intramedullary fixation was found to be technically easy with a lesser complications rate and shorter hospital stay. In a study by Wong et al., they noted while using intramedullary fixation there was K-wire migration and distal perforation of the metacarpal head which can be avoided by using Foucher’s bouquet technique [25]. Since then,the treatment of metacarpal fractures had been extensively discussed and several guidelines are now available [26,27,28].

In a cadaver study by Low et al. (9), palmar dislocation of >30° and shortening of >5 mm resulted in considerable impairment of flexion and extension. This is the reason that we considered surgery for all such cases [29,30,31].

Even though there arereports of very good metacarpal joint functionality after meta carpal fracture healingin an extreme false position [6,29].

the other available surgical methods (open reduction with subsequent screw or plate osteosynthesis; closed reduction with external fixator), intramedullary splinting of metacarpal bones is the mostsimple method, lesser duration of stay and it does not harm the sliding tissue [3,29,30]. Closed reduction with subsequent intramedullary k-wire stabilization of metacarpal bone fractures produces good functional results in the longterm. With a low rate of complications, the method can be recommended for the stabilization of such fractures. The intraoperative need fora C-arm intensifier is the only drawback. Implant removal at the outpatient department is a further advantage.

Closed reduction and intramedullary k-wire fixation of metacarpal bone fractures produce good functional results in the longterm. We found a very low rate of complications and thus recommendthis surgical method for the stabilization of all these types of fractures.

Closed reduction with subsequent intramedullary k-wire stabilization of metacarpal bone fractures produces good functional results in the longterm.

SKK, SU: conceptual framework, data collection.

SU, SS, AV: a review of literature, methodology review.

SKK, SU: manuscript writing and editing.