Abstract
Fifth metacarpal neck fracture commonly requires open reduction and internal fixation. Locking plate was widely adopted in the treatment of fifth metacarpal neck fracture as first-line choice for fixation. Patients with fifth metacarpal neck fracture receiving locking plate fixation were included for analysis. Features of internal fixation including number of distal and proximal locking screws, diameter of the screws and usage of lag screws were recorded. Clinical and radiographic outcomes included final volar angulation, grip strength, Michigan Hand Outcomes Questionnaire (MHQ) and range of motion (ROM) of fifth metacarpophalangeal joint. Three-screw fixation was less frequently presented in the group with increased volar angulation (≥30 degrees). Consistently, three-screw fixation of distal fragment could improve the prognosis compared with two-screw fixation (MHQ 95.4 ± 5.1 versus 80.4 ± 12.3, ROM 83.5 ± 7.2 versus 69.6 ± 7.7). In conclusion, the metacarpal head should be fixed by three locking screws instead of two locking screws.
Highlights
The fifth metacarpal neck fracture accounts for approximately 20% of all fractures in hand[1]
We showed that locking plate in combination with two crossed K-wires could decrease the secondary displacement in volar angulation compared with fixation with locking plate alone in previous study[11]
Secondary displacement in volar angulation which limits the recovery of hand functions could be frequently observed after locking plate fixation, highlighting the need for the improvement of the locking plate fixation
Summary
The fifth metacarpal neck fracture accounts for approximately 20% of all fractures in hand[1]. A biomechanical study showed that final volar angulation more than 30 degrees could lead to decreased ROM of fifth metacarpophalangeal joint and functional impairment[2]. The secondary displacement in volar angulation was frequently observed after locking plate fixation, highlighting the need for improvement. We showed that locking plate in combination with two crossed K-wires could decrease the secondary displacement in volar angulation compared with fixation with locking plate alone in previous study[11]. To the best of our knowledge, there was no previous analysis of the association between these features of locking plate fixation and clinical outcomes. We hypothesized that specific fixation patterns might have a better outcomes compared with the rest ones. We conducted an observational investigation on previous cases to find the better patterns for locking plate fixation
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