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Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning

Résultats du traitement chirurgical des fractures transversales et obliques courtes de la diaphyse du cinquième métacarpien: brochage centromédullaire antérograde versus double brochage centromédullaire antéro- et rétrograde

  • Original Article • HAND - FRACTURES
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Abstract

The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS®, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.

Résumé

Le but de cette étude était d’évaluer une technique permettant un retour plus rapide aux activités antérieures après traitement chirurgical des fractures transversales et obliques courtes de la diaphyse du cinquième métacarpien. Elle consistait en un double brochage centromédullaire antérograde et rétrograde connecté. Notre série comprenait 40 patients d’âge moyen 25 ans dont 2 femmes. Dans 20 cas (groupe I) un brochage centromédullaire antérograde avec une broche de 1.6 ou 2mm a été réalisé suivie d’une orthèse 6 semaines puis autorééducation 2 semaines. Dans 20 cas (groupe II) un double brochage centromédullaire antéro- et rétrograde a été réalisé à l’aide de 2 broches de 1.5 mm reliées par un connecteur (MétaHUS®, Arex™). Une première broche était introduite dans le canal en antérograde, puis la seconde en rétrograde. Les 2 broches extériorisées étaient connectées et l’autorééducation encouragée. Le temps de garrot moyen était 14.75min (groupe I) et 15.8min (groupe II) respectivement. Au dernier recul, la douleur moyenne était de 0.35/10 et 0.2/10, le Quick DASH 0.68/100 et 0.57/100, la force de la poigne 94.65% et 94.35%, la flexion active MCP 98.5% et 99 %, l’extension active MCP 98.5% et 98.75 %, l’arrêt de travail 8.4 et 6.3 semaines. Toutes les fractures ont consolidé sans reprise avec 3 complications : 2 infections sur broches, dans chacun des groupes, 1 SDRC1 (groupe I). Nos résultats semblent montrer que la technique du double brochage centromédullaire antérograde et rétrograde connecté dans le traitement des fractures transversales et obliques courtes de la diaphyse du cinquième métacarpien donne des résultats au moins aussi bons que la technique de référence avec un avantage socioéconomique non négligeable, une moindre durée d’arrêt de travail.

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Acknowledgements

Professor Erik-André Sauleau, Methods Group in Clinical Research, Public Health Service, Strasbourg University Hospitals, who carried out the statistical study.

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Authors and Affiliations

  1. Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France

    Priscille Lazarus, Juan José Hidalgo Diaz, Stéphanie Gouzou, Sybille Facca & Philippe Liverneaux

  2. Department of Surgery (Spine), Dalhousie University, QEII Health Sciences Centre - Halifax Infirmary, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada

    Fred Xaxier

Authors
  1. Priscille Lazarus
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  2. Juan José Hidalgo Diaz
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  5. Sybille Facca
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  6. Philippe Liverneaux
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Correspondence to Philippe Liverneaux.

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Philippe Liverneaux has a relationship with Newclip Technics, Biomodex, Zimmer Biomet, Argomedical. None of the other authors.

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Lazarus, P., Hidalgo Diaz, J.J., Xaxier, F. et al. Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning. Eur J Orthop Surg Traumatol 30, 425–433 (2020). https://doi.org/10.1007/s00590-019-02587-0

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