Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth

Abstract

Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV.

Antegrade nailing using elastic stable intramedullary nail for fifth metacarpal neck fractures in adolescents: ultrasound versus fluoroscopy

“…Management of isolated FNMF includes closed reduction with casting, closed reduction with percutaneous pinning (CRPP) or nailing, open reduction with plating [2][3][4][5][6][7][8][9][10]. Although surgery with various techniques has been reported, nonsurgical treatment remains a preferred choice for patients without signi cant angulation and mal-rotation [1,2].…”

“…Certain authors recommended against surgery for patient with angulation less than 70 degrees, due to limited functional de cit with malunion [15]. In contrast, certain authors recommend surgeries for patient with angulation more than 30 degrees, in order to reduce the possibility of hand functional impairment [5][6][7][8][9][10]. Although open physis exists in adolescents, its remodeling potential is limited due to proximity to skeletal maturity.…”

“…KW is widely used in CRPP of FMNF [16]. However, the risk of articular surface violation and the instability of smooth KW leads to the increasing enthusiasm of ESIN in the treatment FMNF [4,7,8,9]. Single antegrade ESIN has been reported with faster recovery, early function recovery [4,7,9].…”

“…Closed reduction with percutaneous pinning (CRPP) using Kirschner wire (KW) is a simple and effective method for angulated FMNF [5,6]. However, because of its poor stability, possible violation of articular surface, and probably prolonged duration of immobilization, single or double elastic stable intramedullary nail (ESIN) has been reported for xating this fracture [7,8,9,10]. ESIN has been widely applied in the treatment of long bone fracture in children [11].…”

Comparative Evaluation of the Efficacy of Combined Intramedullary Pinning with K-Wires Pinning in the Treatment of Fifth Metacarpal Neck Fractures versus Conventional Techniques—K-Wires Pinning and Intramedullary Pinning

“…Conducted as a retrospective study at a single center, this study's duration spanned from January 2005 to April 2023, utilizing medical records and radiographic images as the primary data sources. The inclusion criteria for this study sought patients aged 18 years or older with a diagnosis of a fifth-metacarpal neck fracture exhibiting angulations exceeding 40 • (the normal range of angulation is <15 • ) [5,6]. The availability of complete medical records and radiographic images after a minimum follow-up of 1 year was also considered.…”