Metacarpal Neck Fractures Research Articles

“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

Background: Fifth metacarpal neck fractures, also known as Boxer’s fractures, commonly occur as a result of axial impact on a clenched fist. There is no agreement over the optimum management of undisplaced boxers fracture. We present the results of treatment by a Bouquet technique, described by Foucher in 143 consecutive cases of displaced fifth metacarpal neck fractures.Methods: We retrospectively reviewed our records for 143 consecutive cases of fifth metacarpal neck fractures treated with Bouquet technique. Clinical and radiological evaluation was done at 6 weeks, 12 weeks and 6 months. Total active motion of the fifth digit, radiography and complications if any were noted.Results: Of 143 cases, there were 113 cases with closed reduction and 30 with open reduction. Radiological union was achieved in 140 cases. Remaining 3 were lost to follow up. Good to excellent result was achieved in 95% cases. Seven cases developed bursitis at the K-wire entry site which required k-wire removal.Conclusion: The technique of flexible antegrade intramedulary nailing of fifth metacarpal neck fractures is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complications.

A prospective study of 15 cases of fifth metacarpal neck fractures treated by antegrade single blunt-tip k wire: Surgical technique, clinico-radiological outcome

A prospective study of 15 cases of fifth metacarpal neck fractures treated by antegrade single blunt-tip k wire: Surgical technique, clinico-radiological outcome

Manual reduction and traction fixation for the treatment of metacarpal neck fractures under ultrasound-guided

To study clinical efficacy of manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided. From April 2013 to August 2016, 30 patients with metacarpal neck fractures were treated with manual reduction and traction fixation under ultrasound-guided, including 26 males and 4 females aged from 14 to 56 years old with an average of (25.6±1.6) years old, the courses of diseases ranged from 7 h to 5 d with an average of (2.7±0.6) d. Twenty patients were the fifth metacarpal neck fracture, 7 patients were the 4th and 5th metacarpal neck fractures, 3 patients were the second metacarpal neck fracture. Fracture healing, angle of bilateral head shaft angle and active range of metacarpophalangeal joints was measured, and DASH score was applied to evaluate function. Twenty-seven patients were followed up from 6 to 11 months with an average of(7.2±0.8) months. Fracture were healed from 5 to 8 weeks with an average of (5.6±0.4) weeks. The affected shaft angle was (15.1±1.8)°, and health head shaft angle was (13.5±2.8)°, while there was no significant difference (t=1.54, P>0.05). The affected range motion of metacarpophalangealjoint was(86.3±2.6)°, health active range motion of metacarpophalangeal joint was(91.8±1.6)°, and no significant difference between both side (t=1.16, P>0.05). DASH score was 4.3±1.5 at 7 months after operation. Manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided could dynamic observe fracture position in time, high patients' acceptability and is a feasible method for the treatment of metacarpal neck fracture.

Simplified internal fixation of fifth metacarpal neck fractures.

Fifth metacarpal neck fractures (boxer's fractures) are common injuries that contribute 20% of all hand fractures. Divergent percutaneous pinning (bouquet fixation) as described by Foucher has gained popularity but is challenging and at times arduous, as it requires the insertion of several slender K-wires into a narrow medullary canal. Here, we report on a simplified technique in which a single thick K-wire is inserted. An 18/10 K-wire is bent at one end then mounted on a drill chuck. The incision is performed and the entry hole created using the K-wire, which is then advanced along the medullary canal. After reduction of the metacarpal head using the Jahss manoeuvre, the K-wire is inserted across the fracture site into the subchondral bone. Any persistent rotational malalignment is corrected by rotating the metacarpal around the K-wire. Immobilisation is by buddy taping covered by a resin guard. We collected follow-up data for 30patients treated using our technique, at a mean age of 32years. 90 days after surgery, the fracture was healed in all patients. No patients had rotational malalignment. Mean operative time was 14minutes. No complications were recorded. The use of a single thick K-wire proved simple, effective, reproducible, and rapid. No rotational malalignment occurred. This technique is faster and easier to perform than divergent pinning with multiple K-wires. This technique can be used to treat fifth metacarpal neck fractures.

Effects of psychological factors on the clinical outcomes of fifth metacarpal neck fractures and their relation to injury etiology.

The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures. The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed. It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42-78), anxiety score 64 (55-77), state anger score 20 (16-30), and Group 2 barrat impulsivity score 61 (55-69), anxiety score 66 (58-72), and anger score 19 (14-26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2. Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

Closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone for treatment of the fifth metacarpal neck fractures

Objective To investigate the surgical technique and clinical effects of closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone in the treatment of the fifth metacarpal neck fractures. Methods From May 2014 to December 2016, 15 cases of the fifth metacarpal neck fractures were treated by closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone. Internal fixators were removed 6 weeks after the operation followed by early postoperative functional training. Results Anatomical reduction or near-anatomical reduction was achieved in 13 cases. Mild angular deformity occurred in 2 cases. All the patients were follow-up for 2 to 3 months. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 13 cases, good in 2 cases. Conclusion Closed reduction and internal fixation with parallel Kirschner wires through the fourth metacarpal bone for treatment of the fifth metacarpal neck fractures can achieve satisfactory clinical effects due to convenient operation, reliable fixation and low cost. Key words: Metacarpal bones; Fractures,bone; Fracture fixation, internal; Closed reduction

Three-screw versus two-screw fixation of distal fragment in fifth metacarpal neck fractures stabilized with locking plate

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.

Iatrogenic Injuries in Percutaneous Pinning Techniques for Fifth Metacarpal Neck Fractures.

There is little information regarding anatomic structures at risk during closed percutaneous treatment of fifth metacarpal neck fractures. This study evaluates a variety of common percutaneous techniques with the hypothesis that each approach presents unique risks to tendons and neurovascular structures. Seven cadaveric hands were used for this study. The senior author, a board-certified hand surgeon with more than 20 years of experience, used a mini-C arm to pass 1.6-mm Kirschner wires (K-wires). The 4 percutaneous techniques employed were anterograde, retrograde, cross-pinning, and transverse fixations. Meticulous superficial dissection was carried out, with fixation from all 4 techniques left in place, to identify any tendons or neurovascular structures penetrated by the K-wires. All techniques demonstrated penetration of at least 1 adjacent structure. The anterograde technique showed penetration of the extensor carpi ulnaris tendon in 5 out of 7 cadavers. In the retrograde approach, the K-wire impaled either the extensor digitorum communis or the extensor digitorum minimi tendons in 4 out of 7 cadavers. The transverse pinning technique exhibited injury to the dorsal cutaneous ulnar nerve in 2 of the specimens. In the retrograde cross-pin technique, there were 2 penetrations of the digital branch of the dorsal cutaneous ulnar nerve. None of the described percutaneous techniques for treating fifth metacarpal neck fractures eliminate the potential for damage to surrounding tendons or nerves. Each technique has at risk structures that the treating surgeon should be aware of in order to anticipate potential complications and counsel patients accordingly.

Abstract: Outcomes of Intramedullary Fixation of Metacarpal Fractures Using Headless Compression Screws: A Literature Review

INTRODUCTION: Metacarpal fractures are a common occurrence in the United States, making up 33.3% of all hand fractures. The majority can be treated nonoperatively, but surgery is indicated when fractures cannot be reduced or fracture alignment cannot be stabilized using closed methods. In 2010, Boulton et al reported intramedullary cannulated headless screw fixation of a comminuted subcapital metacarpal fracture. This method has since been described as an operative technique for displaced, comminuted subcapital, and metacarpal neck and shaft fractures. The purpose of this review is to evaluate the recent studies reporting on the outcomes of intramedullary screw fixation of metacarpal fractures. METHODS: Pubmed, Web of Science, and Cochrane were searched. All outcome data from articles reporting on the use of intramedullary screws for the treatment of metacarpal fractures were combined. RESULTS: A total of five articles, one of which was the original case report, were identified for a total of 115 metacarpal fracture repairs performed using intramedullary screw fixation. The majority (84%) were in the small finger with fracture location in the metacarpal neck (69%). All studies used 2.4mm or 3.0mm screws ranging from 32-50mm in length for fixation. Average follow-up was 14 months with an average MCP flexion of 82 degrees (n=78). One study (n=18) did not record MCP flexion, but reported each digit to have a total active motion >240 degrees. All but one study measured radiographic union as an outcome, and all (n=78) resulted in 100% union at or before the latest follow-up. Additionally, grip strength was assessed in two studies (n=29), which showed an average of at least 98% of the contralateral hand. No serious complications were reported. Only one hardware removal was performed due to radiographic suspicion of intra-articular screw penetration. Of note this was a complication of the Y strutting technique in which two intramedullary screws are placed. CONCLUSION: Intramedullary fixation of metacarpal fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option for metacarpal fractures. Advantages of this technique over previously described methods (intramedullary nail or percutaneous K-wire fixation) include no requirement of K-wire removal and increased rotational stability, thus allowing for earlier mobilization.

Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing

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.

Elastic retrograde intramedullary percutaneous pinning for fifth metacarpal neck fractures: A series of 32 patients

The aim of our study was to evaluate an original surgical technique for the treatment of fifth metacarpal neck fractures: elastic retrograde intramedullary percutaneous pinning (ERIPP). From January 2014 to January 2016, patients with a fifth metacarpal neck fracture with greater than 30° volar displacement and/or clinodactyly were included. All patients underwent an ERIPP procedure. With this technique, K-wires are used as joysticks to assist reduction when the Jahss maneuver is insufficient. Clinical evaluation incorporated the DASH score, range of motion and grip strength at 3months. Radiographic evaluation comprised apex dorsal angulation and metacarpal shortening at 1month and 3months. Thirty-two patients were included in the study. All fractures were healed after a mean of 5 weeks (range 4–7). The DASH score was less than 30 for all patients, indicating an absence of disability. There were no differences in grip strength at 3months between the injured and the contralateral hand. There was less than 10° extension deficit in the metacarpophalangeal joint. In our experience, retrograde percutaneous pinning is a stable, compressive fixation method with effective reduction of displaced fifth metacarpal neck fractures. However, this result needs to be confirmed in comparative studies.

Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail.

The purpose of the current study was to assess the outcome of antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced fifth metacarpal neck fractures. The present study included 69 consecutive juvenile patients with displaced fifth metacarpal fractures. The head-shaft angle of the fifth metacarpal and range of motion (ROM) of the metacarpophalangeal (MCP) joint were evaluated. A disabilities of the arm, shoulder and hand (DASH) questionnaire was used to assess upper arm function. The head-shaft angle of the affected side was significantly improved postoperatively (P<0.05). No marked difference was observed between the affected and unaffected side in head-shaft angle and ROM. The average DASH score was 1.7 (range, 0-6.0). All patients obtained anatomical reduction postoperatively and the average healing time was 5.7±1.09 weeks (range, 5-10 weeks) with no non-union cases. Therefore antegrade intramedullary fixation with TEN is recommended as an easy, reliable and minimally invasive surgical technique for treating displaced fifth metacarpal neck fractures.

Locking Plate Alone versus in Combination with Two Crossed Kirschner Wires for Fifth Metacarpal Neck Fracture

Fracture of fifth metacarpal neck commonly requires open reduction and internal fixation. However, the current methods of internal fixation in fifth metacarpal neck fractures remain unsatisfactory. Patients with fractures of fifth metacarpal neck received open reduction and internal fixation with either locking plate in combination with two crossed Kirschner wires (K-wires) or locking plate alone were evaluated for the clinical outcomes. Clinical outcomes included grip strength, Michigan hand outcomes questionnaire (MHQ), final angulation and range of motion (ROM) one year after treatment. The averages of MHQ scores, final angulation and ROM of fifth metacarpophalangeal joint of plate with K-wire group were more superior to those of plate group (MHQ 96.7 versus 86.6, final angulation 11.8 versus 23.6, ROM 83.3 versus 72.2). The grip strength had no significant difference between two groups. Locking plate in combination with two crossed K-wires is a more optimal method of fixation compared with locking plate alone.

Headless Compression Screw Versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study

This study aimed to determine the biomechanical stability of headless compression screws in the fixation of metacarpal neck fractures and to compare them with another common, less invasive form of fixation, K-wires. The hypothesis was that headless compression screws would show higher stiffness and peak load to failure than K-wire fixation. Eight matched-paired hands (n= 31), using the ring and little finger metacarpals, had metacarpal fractures simulated at the physeal scar. Each group was stabilized with either a 3.5-mm headless compression screw or 2 0.045-in (1.1-mm) K-wires. Nineteen metacarpals were tested in 3-point bending and 12 in axial loading. Peak load to failure and stiffness were calculated from the load displacement curve. Bone mineral density was recorded for each specimen. Bone mineral density was similar in the 2 groups tested for 3-point bending and axial loading. Stiffness was not significantly different in 3-point bending for headless compression screws and K-wires (means, 141.3 vs 194.5 N/mm) but it was significant in axial loading (means, 178.0 vs 111.6 N/mm). Peak load to failure was significantly higher in headless compression screws in 3-point bending (means, 401.2 vs 205.3 N) and axial loading (means, 467.5 vs 198.3 N). Compared with K-wires, headless compression screws for metacarpal neck fractures are biomechanically superior in load to failure, 3-point bending, and axial loading. Headless compression screws demonstrate excellent biomechanical stability in metacarpal neck fractures. In conjunction with promising clinical studies, these data suggest that headless compression screws may be an option for treating metacarpal neckfractures.

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing.

Background: Fifth metacarpal neck fractures (commonly named “boxer’s fractures”) are the most common metacarpal injuries and usually affect young active people. These lesions are mainly treated conservatively. Their surgical management, if indicated, is still a matter of debate. Different procedures have been described. The aim of this study was to evaluate the outcomes of 18 boxer’s fractures which were synthesized with antegrade locked flexible intramedullary nailing. Materials and methods: All patients, at a mean follow-up of 45 months, were clinically evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Patient Rated Wrist/Hand Evaluation (PRWHE). Active and passive range of motion (ROM) of metacarpo-phalangeal (MP), proximal and distal interphalangeal (PIP and DIP) joints and Total Active Motion (TAM), and grip strength were also analyzed. Apex dorsal angulation and axial shortening were radiologically measured preoperatively and at final follow-up. Results: Clinical and radiological results which were observed were satisfactory. No TAM and grip strength differences were recorded between the operated and healthy contralateral hand. Conclusions: According to the positive outcomes and the low rate of complications of this study, antegrade locked flexible intramedullary nailing can be considered a valid treatment option in boxer’s fractures. (www.actabiomedica.it)

Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures: Closed Reduction and Fixation Using Either an Open Antegrade or Percutaneous Retrograde Technique

Although the majority of fifth metacarpal neck fractures can be treated nonoperatively, surgery may be indicated when there is severe shortening or angulation of the metacarpal bone1. Proper positioning of the image intensifier and the treating surgeons is important. Prepare and bend the Kirschner wires before insertion. Create a hole for Kirschner wire insertion in the center of the fifth metacarpal base. Insert the Kirschner wires through the hole of the fifth metacarpal base. An additional skin incision is necessary to remove the Kirschner wires after bone union. Proper positioning of the image intensifier and treating surgeon is important. Reduce the fifth metacarpal neck fracture using the Jahss maneuver. Fix the reduced metacarpal neck fracture using 2 Kirschner wires placed percutaneously in a retrograde direction, with the second wire inserted after the first wire passes the fracture site but before it passes the metacarpal base. The proximal end of the Kirschner wire penetrating outside the dorsal skin of the wrist enables the surgeon to percutaneously retrieve the Kirschner wire after fracture union. The percutaneous Kirschner wire is retrieved. In a previous prospective randomized analysis of patients treated with antegrade intramedullary pinning and percutaneous retrograde intramedullary pinning for displaced fifth metacarpal neck fracture1, we found that the flexion arc of the MCP joint, visual analog pain scale score, grip strength, and DASH (Disabilities of the Arm, Shoulder and Hand) score4 were significantly better in the antegrade intramedullary pinning group at 3 months postoperatively.

Treatments for the Fifth Metacarpal Neck Fractures: A Network Meta-analysis of Randomized Controlled Trials.

The fifth metacarpal neck fractures (commonly termed boxer's fractures) are the most common type of metacarpal fractures. Many types of treatments are available in clinical practice, some of which have already been compared with other treatments by various researchers. However, a comprehensive treatment comparison is lacking. We estimated the comparative efficacy of different interventions for total complications, through a network meta-analysis of randomized controlled trials.We conducted a systematic search of the literature through October 2015. The outcome measurements were the total complications. We used a Bayesian network meta-analysis to combine direct and indirect evidence and to estimate the relative effects of treatment.We identified 6 RCTs registering a total of 288 patients who were eligible for our network meta-analysis. The literature's quality is relatively high. The median Structured Effectiveness for Quality Evaluation of Study score for the included trials was 33.8. The overall methodological quality was high. Of the 6 studies, all were 2-arm controlled trials comparing active intervention. Among the 4 treatments—conservative treatment (CT), antegrade intramedullary nailing (AIMN), transverse pinning (TP) with K-wires, and plate fixation (PF)—CT had the best rankings (ie, lowest risk of total complications), followed by PF, AIMN, and TP (ie, highest risk of total complications). Furthermore, we also presented the results using surface under the cumulative ranking curve. The surface under the cumulative ranking curve probabilities were 94.1%, 52.9%, 37.3%, and 15.7% for CT, PF, AIMN, and TP, respectively.In conclusion, current evidence suggested that conservative treatment is the optimum treatment for the fifth metacarpal neck fractures because of reduced total complication rates. Moreover, the TP with K-wires is the worst option with highly total complication rates. PF and AIMN therapy should be considered as the first-line choices. Larger and higher-quality randomized controlled trials are required to confirm these conclusions and better inform clinical decision-making.

Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures: A Blinded, Randomized Trial.

Use of a hand-based thermoplastic splint for treatment of isolated fifth metacarpal neck fractures in pediatric patients has not previously been studied in a randomized blinded trial. The authors conducted a blinded, 1:1 allocation, two-arm parallel group, superiority design, randomized controlled trial in patients aged 16 years or younger with isolated fifth metacarpal neck fractures. Patients were immobilized for 3 weeks in a conventional forearm-based ulnar gutter or hand-based thermoplastic splint. Primary outcome was difference in active range of motion between splint groups. Secondary outcomes included fracture union, treatment adherence, grip strength, and patient-reported pain and functional outcomes. Between February of 2013 and August of 2014, 40 patients were enrolled in the trial. No differences were observed in baseline characteristics between groups. Mean range of motion was significantly better in the thermoplastic splint group compared with the ulnar gutter splint group at 3 weeks (p = 0.048). All patients had full range of motion at 12 weeks. Treatment adherence was 75 percent and 59 percent for ulnar gutter and thermoplastic splint groups, respectively (p = 0.46). Among ulnar gutter splint patients, decreased grip strength (injured versus noninjured) was observed at 3 and 6 weeks, and was significantly weaker compared with thermoplastic splint patients (p = 0.01). Reported pain scores were similar between groups. Patient-reported functional outcome scores were similar between groups at each time point. No nonunions were observed at 12 weeks. In pediatric patients, hand-based thermoplastic splints resulted in improved early range of motion and grip strength, with no increased pain, nonadherence, or complications compared with conventional ulnar gutter splints. Therapeutic, I.

What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study

ObjectiveThe aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. MethodsAn anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. ResultsWe deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. ConclusionsOblique radiographs at 30̊ of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

A minimally invasive fixation technique for selected patients with fifth metacarpal neck fracture

ObjectiveThe objective of this study was to compare the short-term results of treatment of fifth metacarpal neck fractures using a minimally invasive surgical fixation technique and the gold standard splinting method in a selected patient group of office workers with high expectations. Patients and methodsTwenty-four male patients (mean age: 28 years, range: 18–46 years) satisfying the inclusion criteria were enrolled in the study in two groups: surgical treatment and splinting (U-shaped ulnar gutter) groups. Hygienic interactions during daily activities and the use of keyboard and pens were allowed in the posttreatment period. The Short Form-Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaire was used to assess patient satisfaction and functionality of the extremity on the 30th and 45th days. Joint ranges of motion were measured on the 45th day. Functional and radiological evaluation data were analyzed statistically. ResultsIn the conservative treatment group, initial palmar angulation was measured to be 42.6°, whereas a mean of 13.5° was noted and metacarpal shortening of 5.6mm decreased to 2mm after treatment, respectively. In terms of total joint range of motion (ROM), flexion of the treated side was at 91.25% and extension at 92.5% when measured versus the healthy-side values at the final follow-up. The mean time for return to work in this group was 33.6 days. The mean Quick-DASH score on the 30th-day follow-up was 69.5, whereas it was 39.3 at the 45th-day follow-up. The radiological findings showed a correction of the mean palmar angulation from 43° to 8° at follow-up in the surgically treated group. The initial metacarpal shortening of 9.3mm improved to 0.5mm at final examination. In terms of total joint ROM, flexion of the treated side was at 94% and extension at 95.5% when measured versus the healthy-side values on the 45th-day follow-ups. The mean time for return to work was 3.9 days. The mean Quick-DASH score on the 30th-day follow-up was 2.96, whereas it was noted as 0.69 at the 45th-day follow-up. ConclusionsWe recommend antegrade intramedullary K-wire fixation as a reliable method, which minimizes the functional loss and allows for early return to daily activities in office workers who sustained a fracture of the fifth metacarpal neck.