L-pinning for fifth metacarpal neck fracture in adolescents

Abstract

IntroductionFifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpals. The present study aimed to assess L-pinning without postoperative immobilization in displaced 5th metacarpal fracture in adolescents with low residual growth. Materials and MethodsData for patients aged between 13 and 16 years, operated on for closed 5th metacarpal neck fracture between January 2017 and June 2019, were analyzed retrospectively. Surgery was indicated for angulation with>30° palmar tilt and/or horizontal malalignment. The technique consisted in intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpal heads. No postoperative immobilization was applied. Hardware was removed as of day 28. The final clinical check-up was at≥12 months. ResultsEighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm2. At hardware removal, all patients showed radiologic consolidation. At 3 months, 5th ray ranges of motion were normal, with no local complications. Functional results were maintained at last follow-up (≥12 months). ConclusionL-pinning seemed reliable in terms of feasibility and stability of reduction in 5th metacarpal neck fracture in adolescents. Absence of postoperative immobilization facilitated self-rehabilitation and accelerated functional recovery. Level of evidenceIV.