Reducción cerrada y fijación intramedular de fracturas del cuello del quinto metacarpiano: técnica retrógrada vs. anterógrada. Estudio prospectivo

Abstract

IntroductionThe fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome. Aim of the studyTo compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde versus antegrade Kirschner wires. Material and methodsComparative, longitudinal, prospective study at a third-level trauma center in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week. ResultsSixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilization with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [−26.81; −11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach. ConclusionStabilization with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.