Abstract
Purpose
We investigated the outcomes of the antegrade intramedullary nailing (AIMN) compared to other surgical modalities in the treatment for fifth metacarpal neck fractures via a systematic review.
Methods
Pain, functional scores, grip strength, total active motion (TAM), the range of motion (ROM) of the fifth metacarpal joint, complications and patient satisfaction were set to be the primary outcomes. The data were evaluated using a modified version of the Cochrane Collaboration tool.
Results
We identified four studies, comprising 163 participants, which met the inclusion criteria. Meta-analyses showed that (a) AIMN demonstrated significantly better results in relation to GS at 12 months (p < 0.0001), TAM (p = 0.01) and ROM of the fifth finger (p = 0.0001); (b) AIMN technique yielded significantly lesser residual angulation at the site of fracture (p = 0.05); (c) AIMN significantly demonstrated fewer complications (p = 0.05); (d) there was a trend for better pain scores when using AIMN.
Conclusions
Though the amount of evidence was derived from just four small sample-sized studies, our findings suggested that the AIMN technique could have some advantages over the use of plates or other types of pinning in the treatment for the fifth metacarpal neck fractures. We highlighted the need for a standardization of the outcomes and their corresponding units related to this specific type of fracture. Editors and reviewers should incite authors to provide the standard deviation values for the reported means.
Level of evidence
Therapeutic II.
Similar content being viewed by others
References
Hove LM (1993) Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 27:317–319
Green DP, Rowland SA (1984) Fractures and dislocations in hand. In: Rockwood GA, Green DP (eds) Fractures in adults, vol 1, 2nd edn. JB Lippincott, Philadelphia, pp 313–409
Hunter JM, Cowen NJ (1970) Fifth metacarpal fractures in a compensation clinic population. J Bone Joint Surg 52A:1159–1165
DeJonge JJ, Kingma J, van der Lei B, Klassen HJ (1994) Fracture of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English language literature. Injury 25(6):365–369
Feehan LM, Sheps SB (2006) Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg 31:1068–1074
Gudmundsen TE, Borgen L (2009) Fractures of the fifth metacarpal. Acta Radiol 50(3):296–300
Amadio PC, Beckenbaugh RD, Bishop AT et al (1991) Fractures of the hand and wrist. In: Jupiter JB (ed) Flynn’s hand surgery, 4th edn. Williams & Wilkins, Baltimore, pp 122–185
Green DP, Butler TE (1996) Fractures and dislocations in the hand. In: Rockwood CA, Green DP, Bucholtz RW, Heckman JD (eds) Fractures in adults, vol 1. Lippincott-Raven, Philadelphia, pp 658–664
Jupiter JB, Belsky MR (1992) Fractures and dislocation of the hand. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (eds) Skeletal trauma. Saunders, Philadelphia, pp 959–963
Stern PJ (1993) Fractures of the metacarpals and phalanges. In: Green DP (ed) Operative hand surgery, vol 1. Churchill Livingstone, New York, pp 698–701
Van Demark R (1983) A simple method of treatment of fractures of the fifth metacarpal neck and distal shaft (Boxers’ fractures). S D J Med 36(7):5–7
Harris AR, Beckenbaugh RD, Nettrour JF, Rizzo M (2009) Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand 4(2):161–164
Ford DJ, Ali MS, Steel WM (1989) Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg 14B:165–167
Freeland AE, Geissler WB, Weiss A-PC (2001) Operative treatment of common displaced and unstable fractures of the hand. J Bone Joint Surg Am 83:928–945
Porter ML, Hodgkinson JP, Hirst P, Wharton MR, Cunliffe M (1988) The boxer’s fracture: a prospective study of functional recovery. Arch Emerg Med 5:212–215
Theeuwen GAJM, Lemmens JAM, van Niekerk JLM (1991) Conservative treatment of boxer’s fracture: a retrospective analysis. Injury 22:394–396
Lowdon IM (1986) Fractures of the metacarpal neck of the little finger. Injury 17:189–192
McKerrell J, Bowen V, Johnston G, Zondenvan J (1987) Boxer’s fractures-conservative or operative management? J Trauma 27:486–490
Theeuwen GA, Lemmens JA, van Niekerk JL (1991) Conservative treatment of boxer’s fracture: a retrospective analysis. Injury 22:394–396
Holst-Nielsen F (1976) Subcapital fractures of the four ulnar metacarpal bones. Hand 8:290–293
King JC, Nettrour J, Beckenbaugh RD (1999) Traction reduction and cast immobilization for the treatment of boxer’s fractures. Tech Hand Up Extrem Surg 3:174–180
Ali A, Hamman J, Mass DP (1999) The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 24:835–844
Birndorf MS, Daley R, Greenwald DP (1997) Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 99:1079–1083
Foucher G (1995) “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 20:S86–S90
Gonzalez MH, Igram CM, Hall RF Jr (1995) Flexible intramedullary nailing for metacarpal fractures. J Hand Surg Am 20:382–387
Orbay JL, Touhami A (2006) The treatment of unstable metacarpal and phalangeal shaft fractures with flexible non locking and locking intramedullary nails. Hand Clin 22:279–286
Schadel-Hopfner M, Wild M, Windolf J, Linhart W (2007) Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal? Arch Orthop Trauma Surg 127:435–440
Winter M, Balaguer T, Bessiere C, Carles M, Lebreton E (2007) Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur 32:709–713
Wong TC, Ip FK, Yeung SH (2006) Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br 31:61–65
Manueddu CA, Della Santa D (1996) Fasciculated intramedullary pinning of metacarpal fractures. J Hand Surg Br 21:230–236
Trevisan C, Morganti A, Casiraghi A, Marinoni EC (2004) Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 124:675–680
Westbrook AP, Davis TR, Armstrong D, Burke FD (2008) The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur 33:732–739
Sletten NI, Nordsletten L, Husby T, Ødegaard RA, Hellund JC, Kvernmo HD (2012) Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. J Hand Surg Eur 37(5):387–395
Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P (2010) Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res 96(5):506–512
Fujitani R, Omokawa S, Shigematsu K, Tanaka Y (2012) Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci 17(4):450–456
Strub B, Schindele S, Sonderegger J, Sproedt J, von Campe A, Gruenert JG (2010) Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur 35(9):725–729
Żyluk A, Budzyński T (2009) Conservative vs operative (fixation with k-wires) treatment of isolated fractures of metacarpal bones—results of the prospective, randomized study. Pol Przegl Chir 81(5):217–224
Handoll HHG, Vaghela MV, Madhok R (2007) Percutaneous pinning for treating distal radial fractures in adults. Cochrane Database Syst Rev 3: CD006080
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yammine, K., Harvey, A. Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 24, 273–278 (2014). https://doi.org/10.1007/s00590-013-1344-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-013-1344-5