Antegrade Intramedullary Pinning versus Retrograde Intramedullary Pinning versus Transverse k-Wires Fixation of Neck of 5th Metacarpal Fracture: A Systematic Review

Abstract

Background The 5th metacarpal fractures accounts for 40% of all hand fractures. Neck fractures are the commonest, as it is the weakest point in metacarpals, and accounts for about 10% of all hand fractures. Improper management of hand fractures has negative economic effect due to disabilities that occur to hands of workers, athletes and housewives. Objective To do a systematic review on literature that compares between using the antegrade verses retrograde intra-medullary k-wires and transverse pinning techniques in treatment of fifth metacarpal's neck fracture (boxer's fracture) regarding union, functional outcome and complications. Patients and Methods Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be introduced on the search results and the inclusion/exclusion criteria. Results Application of inclusion and exclusion criteria to study abstracts yielded 8 articles. The full-text articles for these 100 studies were then reviewed and subjected to our inclusion criteria. A total of 8 articles were eligible for final systematic review. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Despite the limitations of this review, we found some evidence that the IM technique could have advantages over the use of transverse pinning in the treatment for the fifth metacarpal neck fractures. The quantitative analyses indicated probable better efficacy of IM particularly in relation to VAS, TAM, active ROM of the fifth ray and residual angulation. Our results can fit into the context of current practice where many hand surgeons consider the IM technique as their preferred method to treat neck fractures of the fifth metacarpal.