Abstract
Introduction
It is generally accepted that severely displaced or malrotated neck fractures of the fifth metacarpal should be treated by closed reduction and pinning. As antegrade intramedullary splinting avoids adhesions of the extensor hood and provides intramedullary stability this technique seems to be advantageous in comparison with traditional retrograde percutaneous crossed pinning. We raised the question whether the antegrade technique would give clinical and radiological results superior to the retrograde technique and investigated this within a comparative clinical study.
Materials and methods
Thirty patients with displaced neck fractures of the fifth metacarpal who received operative treatment were included in a retrospective cohort study. Data was analysed from medical records and a clinical and radiological outcome evaluation was performed. Fifteen patients had antegrade intramedullary splinting and fifteen patients retrograde percutaneous pinning. Median time for follow-up was 17 and 18 months, respectively.
Results
A significantly better outcome was found after antegrade splinting for ROM restriction of the metacarpophalangeal joint (0° vs. −15°; P = 0.016), shortening (P = 0.029), pain (0 vs. 5; VAS 0–100; P = 0.026), and overall assessment by the Steel score (400 vs. 357; P = 0.001). There was no statistical difference in grip strength and functional assessment by the DASH score.
Conclusion
From our clinical and radiological data we conclude that antegrade intramedullary splinting is superior to retrograde percutaneous crossed pinning and thus should be preferentially considered for displaced neck fractures of the fifth metacarpal.
Similar content being viewed by others
References
Abdon P, Mühlow A, Stigsson L, Thorngren KG, Werner CO, Westman L (1984) Subcapital fractures of the fifth metacarpal bone. Arch Orthop Trauma Surg 103:231–234
Arafa M, Haines J, Noble J, Carden D (1986) Immediate mobilization of fractures of the neck of the fifth metacarpal. Injury 17:277–278
Barry P, Regnard PJ, Bensa P (1991) Bundled wiring in fractures of the neck of the fifth metacarpal. 50 cases. Ann Chir Main Memb Super 10:469–475
Beal D, Rongieres M, Mansat M (1991) Bundled central medullary bone wiring. Method of choice in the treatment of fractures of the neck of the fifth metacarpal necessitating a reduction. 30 cases. Ann Chir Main Memb Super 19:463–468
Bloem JJ (1971) The treatment and prognosis of uncomplicated dislocated fractures of the metacarpals and phalanges. Arch Chir Neerl 23:55–65
Bosworth DM (1937) Internal splinting of fractures of the fifth metacarpal. J Bone Joint Surg 19:826–827
Braakman M (1998) Are lateral X-rays useful in the treatment of fractures of the fourth and fifth metacarpals? Injury 29:1–3
Braakman M, Oderwald EE, Haentjens MH (1998) Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 29:5–9
Eichenholtz SN, Rizzo PC (1961) Fracture of the neck of the fifth metacarpal bone—is over-treatment justified? JAMA 178:425–426
Ford DJ, Ali MS, Steel WM (1989) Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg 14B:165–167
Foucher G (1995) “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg 20A:S86–90
Foucher G, Chemorin C, Sibilly A (1976) Nouveau procédé d’ostéosynthèse original dans les fractures du tiers distal du cinquième métacarpien. Nouv Presse Méd 5:1139–1140
Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A (2003) Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma 55:509–513
Harding IJ, Parry D, Barrington RL (2001) The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg 26B:261–263
Holst-Nielsen F (1976) Subcapital fractures of the four ulnar metacarpal bones. Hand 8:290–293
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand). Am J Ind Med 29:602–608
Kermad F, Cazeneuve JF, Hassan Y, Rihan B, Boustani H (2002) Two-pin L fixation of fractures of the fifth metacarpal neck. Acta Orthop Belg 68:231–234
Konradsen L, Nielsen PT, Albrecht-Beste E (1990) Functional treatment of metacarpal fractures 100 randomized cases with or without fixation. Acta Orthop Scand 61:531–534
Kuokkanen HO, Mulari-Keränen SK, Niskanen RO, Haapala JK, Korkala OL (1999) Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg 33:315–317
Larkin G, Brüser P, Safi A (1997) Possibilities and limits of intramedullary Kirschner wire osteosynthesis in treatment of metacarpal fractures. Handchir Mikrochir Plast Chir 29:192–196
Leung YL, Beredjiklian PK, Monaghan BA, Bozentka DJ (2002) Radiographic assessment of small finger metacarpal neck fractures. J Hand Surg 27A:443–448
Lowdon IM (1986) Fractures of the metacarpal neck of the little finger. Injury 17:189–192
Maitra A, Sen B (1990) Displaced boxers’ fractures: a simple and effective method of external splintage. Br J Clin Pract 44:348–351
McKerrell J, Bowen V, Johnston G, Zondervan J (1987) Boxer’s fractures—conservative or operative management? J Trauma 27:486–490
Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA (2005) Conservative treatment for closed fifth (small finger) metacarpal neck fractures, Cochrane Database Syst Rev 3, CD003210
Porter ML, Hodgkinson JP, Hirst P, Wharton MR, Cunliffe M (1988) The boxers’ fracture: a prospective study of functional recovery. Arch Emerg Med 5:212–215
Prokop A, Kulus S, Helling HJ, Burger C, Rehm KE (1999) Are there guidelines for the treatment of metacarpal fractures? Personal results and literature analysis of the last 12 years. Unfallchirurg 102:50–58
Smith RJ, Peimer CA (1977) Injuries to the metacarpal bones and joints. Adv Surg 11:341–374
Steel WM (1988) Articular fractures. In: Barton NJ (ed) Fractures of the hand and wrist. Churchill Livingstone, New York, pp 55–73
Theeuwen GA, Lemmens JA, van Niekerk JL (1991) Conservative treatment of boxer’s fracture: a retrospective analysis. Injury 22:394–396
Trabelsi A, Dusserre F, Asencio G, Bertin R (2001). Traitement orthopédique des fractures du col du cinquième métacarpien: ètude prospective. Chir Main 20:226–230
Wong TC, Ip FK, Yeung (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 31B:61–65
Acknowledgments
The authors would like to thank Professor Martin Scholz (Heinrich Heine University Düsseldorf) for linguistic review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schädel-Höpfner, M., Wild, M., Windolf, J. et al. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?. Arch Orthop Trauma Surg 127, 435–440 (2007). https://doi.org/10.1007/s00402-006-0254-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-006-0254-y