Simple percutaneous pinning for management of unstable fifth metacarpal neck fractures

Abstract

Background The purpose of this prospective study was to evaluate the clinical and radiographic outcomes of our new surgical technique, percutaneous antegrade intramedullary pinning, for the management of unstable displaced fifth metacarpal neck fractures. Patients and methods Between 2010 and 2014, 40 patients who met the inclusion criteria were invited for clinical and radiological follow-up. There were 38 males and two females. The mean age was 28 years. Clinical assessments included active range of motion of the injured fifth metacarpophalangeal (MP) joint; visual analog scale score for pain; grip strength; and disabilities of the arm, shoulder, and hand score. Radiological evaluation included angulation and shortening of the fifth metacarpal. Results The average follow-up duration was 18 months. Regarding clinical outcomes, the mean active range of motions of the fifth MP joints were 87°, the median visual analog scale scores were 0, the mean grip strengths were 95%, the mean disabilities of the arm, shoulder, and hand scores were 3, and mean period for return to work was 6 weeks. Regarding radiological outcomes, all fractures healed at a mean of 5.85 weeks, the mean residual angulation was 4°, and the mean postoperative shortening was 0.5 mm. Conclusion This technique is straightforward, and there is no incisional scar. The wires do not violate the MP joint that makes early joint motion possible. The operative time is relatively short compared with previous techniques. All patients in the study group had satisfactory clinical and radiographic outcomes. Level of evidence: therapeutic level IV, case series.