Abstract
BackgroundThe aim of this study was to investigate clinical outcomes of fifth metacarpal neck fractures using antegrade single elastic nail and to explore ideal puncture point to avoid iatrogenic ulnar nerve injury.MethodsA single elastic nail with suitable diameter was used in 27 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 5 weeks postoperatively.ResultsAt final follow up, all fractures proceeded to bony union. The mean total passive motion was 285° and the mean total active motion (TAM) was 270°. The mean angulation decreased from 50.2 ± 6.3° preoperatively to 7.4 ± 2.3° postoperatively (p < 0.001). The mean DASH-Score was 2.1 ± 3.6 points after surgery. Two cases of skin irritation and one case of the dorsal cutaneous branch of the ulnar nerve (DCBUN) injury were observed. Superficial wound infections were not observed.ConclusionsCollectively, antegrade single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with dorsal angulation over 45°. Appropriate puncture position helped to reduce nerve damage.
Highlights
The aim of this study was to investigate clinical outcomes of fifth metacarpal neck fractures using antegrade single elastic nail and to explore ideal puncture point to avoid iatrogenic ulnar nerve injury
The fifth metacarpal neck fracture generally presented palmar angulation owing to the force of the interosseous muscles [4]
The purpose of the present study was to retrospectively investigate the clinical outcomes using antegrade single elastic intramedullary nailing for fifth metacarpal fractures
Summary
The aim of this study was to investigate clinical outcomes of fifth metacarpal neck fractures using antegrade single elastic nail and to explore ideal puncture point to avoid iatrogenic ulnar nerve injury. Fifth metacarpal neck fracture (known as boxer’s fractures) is the most common type of hand bone fractures. It amounts to 5% of all fractures in the upper extremity [1,2,3]. The fifth metacarpal neck fracture generally presented palmar angulation owing to the force of the interosseous muscles [4]. There were many controversies in the treatment of the fifth metacarpal neck fracture [5, 6]. Conservative treatment with reduction and immobilization was successful in most cases [7, 8]. A dorsal angulation less than 45 degrees can be treated conservatively [9]. A fracture angle greater than 45 degrees produces significant muscle shortening which
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