Elastic retrograde intramedullary percutaneous pinning for fifth metacarpal neck fractures: A series of 32 patients

Poumellec, Marie-Anne; Dreant, Nicolas

doi:10.1016/j.hansur.2017.04.004

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…However, there is no agreement. Some use a true lateral view (Amsallem et al., 2018; Strub et al., 2010), some a 25° pronated view (Sadiq and Hussain, 2019), others a 30° supinated view (Poumellec and Dreant, 2017) or a 30° pronated view (Kaynak et al., 2019; Kim and Kim, 2015; Surke et al., 2020; Wong et al., 2015). Leung et al.…”

Section: Discussion About Review 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: Discussion About Review Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…However, this technique has the disadvantage of excessive soft tissue damage, which may lead to complications such as tendon adhesion, severe tendon irritation, and joint stiffness 22,23 . Retrograde intramedullary nailing fixation with K-wires, or elastic nails have been reported for the treatment of FMNFs, but these techniques cause tendon irritation and MCP stiffness 24 . The use of a retrograde headless intramedullary screw has shown good outcomes 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Single versus dual elastic nails for closed reduction and antegrade intramedullary nailing of displaced fifth metacarpal neck fractures

Zeng

Miao

et al. 2021

Sci Rep

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Closed reduction and internal fixation with antegrade intramedullary nails is a feasible and effective treatment for displaced fifth metacarpal neck fractures (FMNFs). The present study aimed to compare clinical and radiological outcomes in patients with displaced FMNFs after treatment with single or dual antegrade elastic intramedullary nails (AEIMNs). Thirty-three patients were treated with a single 2.0 mm AEIMN and 34 patients were treated with two 1.5 mm AEIMNs. Clinical and radiological outcomes included grip strength, active range of motion (ROM), active flexion and extension of the fifth metacarpophalangeal (MCP) joint, dorsal angulation loss, and metacarpal shortening of the fifth metacarpal at 12 months after treatment. No significant difference was observed between the two groups with respect to grip strength, ROM or flexion of the fifth MCP joint. The average values of dorsal angulation loss, metacarpal shortening, and extension of the fifth MCP joint of the dual nails group were better than those of the single nail group (dorsal angulation loss, 2.79 ± 1.93° vs. 4.05 ± 1.59°, P = 0.009; metacarpal shortening, 1.66 ± 0.80 mm vs. 2.12 ± 0.88 mm, P = 0.028; extension of the fifth MCP joint, 7.71 ± 4.43° vs. 4.82 ± 4.09°, P = 0.012). In conclusion, dual AEIMNs fixation provided better MCP extension and radiological outcomes than single AEIMN fixation.

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“…ESIN has been widely applied in the treatment of long bone fracture in children [11]. Moreover, the application of ESIN in FMNF produces satisfactory clinical function, and it could be performed in minimally invasive fashion [12,13].…”

Section: Introductionmentioning

confidence: 99%

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

Liu,

Wu,

Wang

et al. 2024

Preprint

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Introduction: Fractures of the fifth metacarpal neck (FMNF) represent a common hand injury, often amenable to conservative management. However, in adolescents with significant displacement or rotational deformity, surgical intervention may be warranted to achieve optimal functional recovery. This study aims to juxtapose the clinical outcomes of percutaneous pinning using Elastic Stable Intramedullary Nailing (ESIN) under fluoroscopic versus ultrasound guidance. Methods: We conducted a retrospective analysis encompassing 42 patients aged 10 to 16 diagnosed with FMNF. Patients were stratified into cohorts based on the modality employed for procedural guidance, distinguishing between those guided by ultrasound and fluoroscopy. Comprehensive demographic and clinical parameters were meticulously documented for both cohorts. Furthermore, the pre- and post-operative alterations in Horizontal Metacarpal Phalangeal Angle (HSA) and Metacarpal Phalangeal Joint Range of Motion (MPJ ROM) were meticulously scrutinized to ascertain surgical efficacy. Results: Notably, parameters such as Pre-operative HSA, Post-operative HSA, and MPJ ROM exhibited no statistically discernible disparities between the ultrasound-guided cohort and their fluoroscopy-guided counterparts (P > 0.05). Conclusions: Evidently, closed reduction coupled with percutaneous pinning under ultrasound guidance emerges as a viable therapeutic modality for adolescent FMNF cases. Importantly, it yields clinical outcomes commensurate with those achieved through percutaneous pinning conducted under fluoroscopy.

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Elastic retrograde intramedullary percutaneous pinning for fifth metacarpal neck fractures: A series of 32 patients

Cited by 6 publications

References 16 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

Single versus dual elastic nails for closed reduction and antegrade intramedullary nailing of displaced fifth metacarpal neck fractures

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

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