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Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?
Summary Introduction Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plat...
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Published in: | Orthopaedics & traumatology, surgery & research surgery & research, 2010-09, Vol.96 (5), p.506-512 |
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description | Summary Introduction Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. Hypothesis The present study compared results between locking plates and intramedullary K-wires. Material and methods The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). Results No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Discussion Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks’ immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level of evidence Level IV continuous prospective comparative study. |
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Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. Hypothesis The present study compared results between locking plates and intramedullary K-wires. Material and methods The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). Results No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Discussion Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks’ immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level of evidence Level IV continuous prospective comparative study.</description><identifier>ISSN: 1877-0568</identifier><identifier>EISSN: 1877-0568</identifier><identifier>DOI: 10.1016/j.otsr.2010.02.009</identifier><identifier>PMID: 20580630</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Adolescent ; Adult ; Bone Plates ; Bone Wires ; Female ; Fifth metacarpal fracture ; Fracture ; Fracture Fixation, Internal - methods ; Fracture Fixation, Intramedullary - methods ; Fracture Healing - physiology ; Humans ; K-wire ; Locking plate ; Male ; Metacarpal Bones - injuries ; Metacarpal Bones - surgery ; Middle Aged ; Orthopedics ; Physical Therapy Modalities ; Postoperative Care - methods ; Postoperative Complications - diagnosis ; Postoperative Complications - rehabilitation ; Postoperative Complications - surgery ; Prospective Studies ; Range of Motion, Articular - physiology ; Reoperation ; Surgery ; Young Adult</subject><ispartof>Orthopaedics & traumatology, surgery & research, 2010-09, Vol.96 (5), p.506-512</ispartof><rights>Elsevier Masson SAS</rights><rights>2010 Elsevier Masson SAS</rights><rights>Copyright © 2010 Elsevier Masson SAS. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c454t-55f247dc2d6d26221953d157d4a7772fe74538db9716048232908043158364b73</citedby><cites>FETCH-LOGICAL-c454t-55f247dc2d6d26221953d157d4a7772fe74538db9716048232908043158364b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20580630$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Facca, S</creatorcontrib><creatorcontrib>Ramdhian, R</creatorcontrib><creatorcontrib>Pelissier, A</creatorcontrib><creatorcontrib>Diaconu, M</creatorcontrib><creatorcontrib>Liverneaux, P</creatorcontrib><title>Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?</title><title>Orthopaedics & traumatology, surgery & research</title><addtitle>Orthop Traumatol Surg Res</addtitle><description>Summary Introduction Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. Hypothesis The present study compared results between locking plates and intramedullary K-wires. Material and methods The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). Results No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Discussion Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks’ immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level of evidence Level IV continuous prospective comparative study.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Bone Plates</subject><subject>Bone Wires</subject><subject>Female</subject><subject>Fifth metacarpal fracture</subject><subject>Fracture</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fracture Fixation, Intramedullary - methods</subject><subject>Fracture Healing - physiology</subject><subject>Humans</subject><subject>K-wire</subject><subject>Locking plate</subject><subject>Male</subject><subject>Metacarpal Bones - injuries</subject><subject>Metacarpal Bones - surgery</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Physical Therapy Modalities</subject><subject>Postoperative Care - methods</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - rehabilitation</subject><subject>Postoperative Complications - surgery</subject><subject>Prospective Studies</subject><subject>Range of Motion, Articular - physiology</subject><subject>Reoperation</subject><subject>Surgery</subject><subject>Young Adult</subject><issn>1877-0568</issn><issn>1877-0568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi0EoqXwBzig3DhlGX87CFGhqi2IlTgAZ8trT8C72WSxnUL_fR1tQYgDJ4-s93mleYaQ5xRWFKh6tV1NJacVg_oBbAXQPSCn1GjdglTm4V_zCXmS8xZAKcrZY3LCQBpQHE7J5VXsy_dmj8V5lw5uaEb0u6ZPzpc5YdPHX67EaXzdrCe_i-O35jC4gs0Npjzn5mP7MyY8f0oe9W7I-Oz-PSNfry6_XLxv15-uP1y8W7deSFFaKXsmdPAsqMAUY7STPFCpg3Baa9ajFpKbsOk0VSAM46wDA4JTabgSG83PyMtj7yFNP2bMxe5j9jgMbsRpztZIbSgVRtUkOyZ9mnJO2NtDinuXbi0Fu9izW7vYs4s9C8xWexV6cV8_b_YY_iC_ddXAm2MA65I3EZPNPuLoMVQLvtgwxf_3v_0H90Mco3fDDm8xb6c5jVWfpTZXwH5e7recjwIseMfvAKcUkxM</recordid><startdate>20100901</startdate><enddate>20100901</enddate><creator>Facca, S</creator><creator>Ramdhian, R</creator><creator>Pelissier, A</creator><creator>Diaconu, M</creator><creator>Liverneaux, P</creator><general>Elsevier Masson SAS</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100901</creationdate><title>Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?</title><author>Facca, S ; Ramdhian, R ; Pelissier, A ; Diaconu, M ; Liverneaux, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c454t-55f247dc2d6d26221953d157d4a7772fe74538db9716048232908043158364b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Bone Plates</topic><topic>Bone Wires</topic><topic>Female</topic><topic>Fifth metacarpal fracture</topic><topic>Fracture</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fracture Fixation, Intramedullary - methods</topic><topic>Fracture Healing - physiology</topic><topic>Humans</topic><topic>K-wire</topic><topic>Locking plate</topic><topic>Male</topic><topic>Metacarpal Bones - injuries</topic><topic>Metacarpal Bones - surgery</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Physical Therapy Modalities</topic><topic>Postoperative Care - methods</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - rehabilitation</topic><topic>Postoperative Complications - surgery</topic><topic>Prospective Studies</topic><topic>Range of Motion, Articular - physiology</topic><topic>Reoperation</topic><topic>Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Facca, S</creatorcontrib><creatorcontrib>Ramdhian, R</creatorcontrib><creatorcontrib>Pelissier, A</creatorcontrib><creatorcontrib>Diaconu, M</creatorcontrib><creatorcontrib>Liverneaux, P</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Orthopaedics & traumatology, surgery & research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Facca, S</au><au>Ramdhian, R</au><au>Pelissier, A</au><au>Diaconu, M</au><au>Liverneaux, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?</atitle><jtitle>Orthopaedics & traumatology, surgery & research</jtitle><addtitle>Orthop Traumatol Surg Res</addtitle><date>2010-09-01</date><risdate>2010</risdate><volume>96</volume><issue>5</issue><spage>506</spage><epage>512</epage><pages>506-512</pages><issn>1877-0568</issn><eissn>1877-0568</eissn><abstract>Summary Introduction Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. Hypothesis The present study compared results between locking plates and intramedullary K-wires. Material and methods The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). Results No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Discussion Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks’ immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level of evidence Level IV continuous prospective comparative study.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>20580630</pmid><doi>10.1016/j.otsr.2010.02.009</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Bone Plates Bone Wires Female Fifth metacarpal fracture Fracture Fracture Fixation, Internal - methods Fracture Fixation, Intramedullary - methods Fracture Healing - physiology Humans K-wire Locking plate Male Metacarpal Bones - injuries Metacarpal Bones - surgery Middle Aged Orthopedics Physical Therapy Modalities Postoperative Care - methods Postoperative Complications - diagnosis Postoperative Complications - rehabilitation Postoperative Complications - surgery Prospective Studies Range of Motion, Articular - physiology Reoperation Surgery Young Adult |
title | Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? |
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