Minimally invasive antegrade intramedullary fixation for unstable subcapital fracture of the fifth metacarpal by single elastic nail

Abstract

Background Fractures of the neck of the fifth metacarpal are common and mainly occur in young men. The injury often occurs through aggression, such as a fist fight or punching a hard object. The aim of this study was to assess clinical and radiological outcomes of fifth metacarpal neck fractures using minimally invasive antegrade single intramedullary fixation prepending elastic nails in the selected patients and to explore the ideal puncture point to avoid iatrogenic ulnar nerve injury. Patients and methods A single elastic nail with suitable diameter was used in 24 cases of fifth metacarpal neck fractures with dorsal angulation over 45°. An initial entry point was perforated at the ulnar-dorsal base of the metacarpal. The nail was inserted in an antegrade approach. The nail was usually removed at about 8 weeks postoperatively. Results This study reported the results of 24 patients who were affected by closed fractures of the neck of the fifth metacarpal bone (boxer’s fracture) and were treated with percutaneous single elastic intramedullary nailing to verify the effectiveness of this surgical treatment. The average follow-up period was 20.75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal range of motion, and time to union. At the final follow-up, no patient reported residual pain, and all fractures proceeded to bony union. Conclusion The authors recommend that this percutaneous single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with good functional results and low morbidity.