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

• Published in: Injury 2016-06, Vol.47 (6), p.1270-1275
• Main Authors: Cepni, Serdar Kamil, Aykut, Serkan, Bekmezci, Taner, Kilic, Ayhan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bone Wires; Boxer's fracture; Fifth metacarpal; Fracture; Fracture Fixation, Intramedullary - methods; Fractures, Bone - diagnostic imaging; Fractures, Bone - physiopathology; Fractures, Bone - surgery; Hand Injuries - physiopathology; Hand Injuries - surgery; Hand Strength; Humans; IM nailing; Male; Metacarpal Bones - diagnostic imaging; Metacarpal Bones - injuries; Metacarpal Bones - surgery; Middle Aged; Minimally invasive; Minimally Invasive Surgical Procedures; Radiography; Recovery of Function; Return to Work; Treatment Outcome; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.01.034

The 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. Twenty-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. In 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. We 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.