Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail

BMC Musculoskelet Disord

Zhang

et al. 2021

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.

Section: Discussionsupporting

confidence: 90%

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

Fan

BMC Musculoskelet Disord

Zhang

et al. 2021

“…Contrary to the contralateral, almost no apex dorsal angular malformation was found. All outcomes were in close agreement with some previous studies, in which elastic intramedullary nailing was used to treat adolescents with FMNF [9,29]. The results proved that AIMN with K-wire is a straightforward, reliable, and minimally invasive surgical technique.…”

Section: Discussionsupporting

confidence: 89%

Antegrade Intramedullary Fixation for Adolescent Fifth Metacarpal Neck Fracture and its Impact on Epiphyseal Growth

Fan

Zhang

et al. 2021

Preprint

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 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 K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were total displacement, malrotation deformity, and apex dorsal angulation of greater than 40°. 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, 17 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.8±1.1 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.5°±2.6° to 15.7°±2.5° (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 1.7 (range, 0–4), the mean VAS was 0.18±0.6 (range, 0–2), and the mean grip strength was 91.5%±4.5% (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 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.

“…Additionally, through a summary of the postoperative imaging and joint range of motion of 55 cases, they found that ESIN treatment of metacarpal fractures could provide early restoration of joint range of motion and had a low incidence of complications. Shen et al 19 summarized 69 cases of elastic intramedullary nails for the treatment of juvenile fifth metacarpal neck fractures and proposed that anterograde insertion of elastic intramedullary nails has strong stability, induces minimal trauma, and results in almost no damage to the juvenile epiphysis. In a study by Lieber et al, 20 one patient developed nerve and tendon injury due to excessive pursuit of ESIN stability, and the authors cautioned that attention should be paid to the distance between the ESIN head and the articular surface when the ESIN needle is inserted.…”

Section: Literature Reviewmentioning

confidence: 99%

Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing

Deng

et al. 2023

J Int Med Res

Objective This retrospective study compared two minimally invasive surgical methods for fifth metacarpal neck fractures in adolescents: percutaneous Kirschner wire (K-wire) fixation and elastic stable intramedullary nailing (ESIN). Methods This study involved 42 adolescents aged 11 to 16 years with fifth metacarpal neck fractures treated by either K-wire fixation (n = 20) or ESIN (n = 22). The palmar tilt angle and shortening were compared on radiographs preoperatively and 6 months postoperatively. Total active range of motion (TAM), the visual analogue scale score for pain, and the Disabilities of the Arm, Shoulder and Hand score for upper limb function were recorded at 5 weeks, 3 months, and 6 months postoperatively. Results The mean TAM was significantly greater in the ESIN than K-wire group at all postoperative time points. The mean external fixation time was 2 weeks longer in the K-wire than ESIN group. One patient in the K-wire group developed infection. There was no statistically significant difference between the two groups in other postoperative outcomes. Conclusions ESIN fixation has the advantages of greater stability, better activity, a shorter external fixation time, and a lower infection rate than K-wire fixation in the treatment of fifth metacarpal neck fractures in adolescents.