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

Çepni, Serdar Kamil; Aykut, Serkan; Bekmezci, Taner; Kilic, Ayhan

doi:10.1016/j.injury.2016.01.034

Cited by 19 publications

(19 citation statements)

References 14 publications

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“…Four studies commented on this issue. Cepni et al. (2016) noted that the mean palmar angulation improved from 43° before treatment to 14° at 1.5 months follow-up in the group treated with reduction and an ulnar gutter cast.…”

Section: Resultsmentioning

confidence: 87%

“…Eight of the 11 studies reporting on conservative treatment included patients that clearly exceeded a palmar angulation of 30° (i.e. 50° or more) (Bansal and Craigen, 2007; Cepni et al., 2016; Kuokkanen et al., 1999; Pellat et al., 2019; Sletten et al., 2015; Statius Muller et al., 2003; Strub et al., 2010; van Aaken et al., 2016). Three of these seven studies commented on the correlation between palmar angulation (initial or residual) and the clinical results.…”

Section: Resultsmentioning

confidence: 99%

“…Especially palmar angulation has been intensively debated. While many use an angulation threshold of 40° or even 60° (Cepni et al., 2016; Chen et al., 2020; Eldridge and Apau, 2015; Elmowafy et al., 2018; Facca et al., 2010; Fujitani et al., 2012; Kaynak et al., 2019; Kim and Kim, 2015; Ozturk et al., 2008; Pogliacomi et al., 2017; Potenza et al., 2012; Poumellec and Dreant, 2017; Rhee et al., 2012; Sadiq and Hussain, 2019; She and Xu, 2017), still a maximal angulation of 30° has been the guideline in many recent studies (Amsallem et al., 2018; Galal and Safwat, 2017; Kim and Kim, 2015; Surke et al., 2020; Tank et al., 2018; Winter et al., 2007; Wong et al., 2015). Rotational deformity must also be taken in account, although this rarely is a problem with neck fractures of the fifth metacarpal.…”

Section: Introductionmentioning

confidence: 99%

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Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Boeckstyns

2020

J Hand Surg Eur Vol

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Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Boeckstyns

2020

J Hand Surg Eur Vol

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“…Most of the fractures are simple, closed and stable and are treated conservatively. 1,2,4,6 If the fractures are not stabilized properly cosmetic and functional problems may occur. 5 Closed reduction of displaced metacarpal neck fracture is reported to be difficult to achieve and impossible to retain in reduced position by non-operative methods.…”

Section: Discussionmentioning

confidence: 99%

“…Displacement of the head in the direction of flexion tends to heal poorly as a result of the deforming force of intrinsic muscles. 6,7 Both cosmetic disfiguration and functional loss may occur in cases with inappropriate reduction and fixation Surgery is recommended when clinical malrotation of fifth finger as noted on flexion and longitudinal shorting more than 3 mm. Several surgical techniques has been used such as antegrade intramedullary K-wire, retrograde intramedullary K-wire, retrograde cross pinning with kwire, transverse pinning K-wire, external fixation, intraosseous wiring and plate fixation A.…”

Section: Introductionmentioning

confidence: 99%

Management of boxers fracture with single antegrade bent K-wire

Sadiq

Hussain

2019

Int J Res Orthop

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Background: Fractures of the neck of fifth metacarpal are commonly encountered in orthopaedic practice. Management of these fractures is a debatable topic with treatment varying from conservative management to surgical fixation. In our study we used a pre-bent k wire in antegrade fashion to achieve fracture fixation. We found that pre-bent K wire provides an excellent reduction with good correction of neck shaft angle and good restoration of movements at the metcarpo-phalyngeal and inter-phalyngeal joints. Pre-bent K wire provides an efficient and economical modality of fixation in fracture neck of fifth metacarpal fractures.Methods: All patients presenting with fracture neck of fifth metacarpal were managed by pre-bent K wire in antegrade fashion by a single surgeon using a single prebent K wire.Results: All the fractures involved the dominant hand (16 right and 6 left). The mean duration of surgery was 24 mins. Intra operatively the mean no of X ray shoots were 12. At the end of the follow-up there was no significant difference in the TAM in the affected and the unaffected hand. The p=0.17. The mean DASH at the end of the follow up was 2.42. The mean fracture healing time was 45 days.Conclusions: Boxers fracture is very common fracture type in young active adults. Conservative management is usually associated with shorting and angular deformities. Percutenous fixation of the fracture with bent K wire placed in antegrade fashion provides good stability at the fracture site.

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Non-operative management of metacarpal II-IV fractures: A retrospective study from a tertiary hand unit

Turna,

Stringer,

Jemec

et al. 2024

Journal of Plastic, Reconstructive & Aesthetic Surgery

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

Cited by 19 publications

References 14 publications

Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Management of boxers fracture with single antegrade bent K-wire

Non-operative management of metacarpal II-IV fractures: A retrospective study from a tertiary hand unit

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