Abstract
Background: Fifth metacarpal neck fractures, also known as Boxer’s fractures, commonly occur as a result of axial impact on a clenched fist. There is no agreement over the optimum management of undisplaced boxers fracture. We present the results of treatment by a Bouquet technique, described by Foucher in 143 consecutive cases of displaced fifth metacarpal neck fractures.Methods: We retrospectively reviewed our records for 143 consecutive cases of fifth metacarpal neck fractures treated with Bouquet technique. Clinical and radiological evaluation was done at 6 weeks, 12 weeks and 6 months. Total active motion of the fifth digit, radiography and complications if any were noted.Results: Of 143 cases, there were 113 cases with closed reduction and 30 with open reduction. Radiological union was achieved in 140 cases. Remaining 3 were lost to follow up. Good to excellent result was achieved in 95% cases. Seven cases developed bursitis at the K-wire entry site which required k-wire removal.Conclusion: The technique of flexible antegrade intramedulary nailing of fifth metacarpal neck fractures is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complications.
Highlights
Fifth metacarpal neck fractures are interesting due to the frequency of their occurrence and numerous modalities of their treatment, namely compression bandage, functional splinting, closed reduction and splinting, transfixation or cross K wiring, intramedulary wire fixation, open reduction and plate or tension band wire fixation, external fixation etc
Various reports suggest that it is almost impossible to maintain the reduction by non-operative means. [7,9,20,21,28,37,43,46] This leads to persistent deformity and morbidity in almost every case of displaced fifth metacarpal neck fracture treated non-operatively
Patients with isolated displaced fifth metacarpal neck fractures were treated with this method by two surgeons between 2003 and 2011
Summary
Fifth metacarpal neck fractures are interesting due to the frequency of their occurrence and numerous modalities of their treatment, namely compression bandage, functional splinting, closed reduction and splinting, transfixation or cross K wiring, intramedulary wire fixation, open reduction and plate or tension band wire fixation, external fixation etc. All the treatment modalities have reported good functional and end results.[15,9,17,32,45,46]. [7,9,20,21,28,37,43,46] This leads to persistent deformity and morbidity in almost every case of displaced fifth metacarpal neck fracture treated non-operatively. There are number of patients unwilling to accept the cosmetic deformity of the knuckle that occurs in nearly every case of conservative treatment. We present the results of treatment by a Bouquet technique, described by Foucher in 143 consecutive cases of displaced fifth metacarpal neck fractures. Methods: We retrospectively reviewed our records for 143 consecutive cases of fifth metacarpal neck fractures treated with Bouquet technique. Total active motion of the fifth digit, radiography and complications if any were noted
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