Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases).

Hassan Boussakri,Mohamad Azarkane,Soufiane Bensaad,Mohamed Shimi,Mohammed Bachiri,Abdelmajid Elmrini,Abdelhalim Elibrahimi,Mohamad Elidrissi

doi:10.11604/pamj.2014.18.187.3347

Abstract

This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture( boxers’ fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity.

Highlights

Fractures of the metacarpal bones are very common injuries of the skeletal system and, in approximately 50% of the cases, involve the neck of the fifth metacarpal bone [1]
The purpose of this study was to report the medium-term results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone, treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment
There is only one patient presented a bad result overall TPM =250 and TMA= 170, of a complicated reflex sympathetic dystrophy. The aim of this retrospective study was to assess the clinical and radiographic results of percutaneous intramedullary nailing fixation with single Kirschner wire (K-wire) in fractures of the neck of the fifth metacarpal bone .the Boxer's fractures are very common injuries[13,14].Which can cause impairment of hand function [15-17], When they heal in malrotation and/or in volar angulation of the metacarpal head and the result may be a loss of the grip strength and an extension deficit of the little finger

Summary

Introduction

Fractures of the metacarpal bones are very common injuries of the skeletal system and, in approximately 50% of the cases, involve the neck of the fifth metacarpal bone [1]. The Metacarpal neck fractures are among the most common of hand fractures with those involving the fifth metacarpal (boxer's fractures) being the most common [2].These fractures result from a longitudinal compression force acting on a flexed metacarpophalangeal joint (MCP) — usually when a clenched fist strikes a solid object, The resultant fracture is usually unstable with volar angulation due to comminution of the volar cortex and the deforming action of the interossei [3].These fractures are frequently observed in active young men, occur in the dominant hand and are typical injuries of aggression (boxer's fractures) [4,5].their treatment can be problematic[ 3],many treatments are numerous: functional treatment by a simple syndactylisation with risk of secondary displacement[6,7];the Conservative treatment consists of a cast immobilization, but sometimes source of skin complications [8,9], and there are Various fixation techniques in use are : a direct osteosynthesis [ 10]; percutaneous pinning [ 11]; plating [12] and percutaneous transverse pinning [1].

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Conclusion