Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing

Abstract

Background: The aim of this study was to investigate clinical outcomes of fifth metacarpal neck fractures using antegrade single elastic nail and to explore ideal puncture point to avoid iatrogenic ulnar nerve injury. Methods: A single elastic nail with suitable diameter was used in 27 cases of fifth metacarpal neck fractures with dorsal angulation over 45°. An initial entry point was perforated at the ulnar-dorsal base of the metacarpal. The nail was inserted in an antegrade approach. The nail was usually removed at about 5 weeks postoperatively. Results: At final follow up, all fractures proceeded to bony union. The mean total passive motion was 285°and the mean total active motion (TAM) was 270°. The mean angulation decreased from 50.2 ± 6.3°preoperatively to 7. 4 ± 2.3°postoperatively (p < 0.001). The mean DASH-Score was 2.1 ± 3.6 points after surgery. Two cases of skin irritation and one case of the dorsal cutaneous branch of the ulnar nerve (DCBUN) injury were observed. Superficial wound infections were not observed. Conclusions: Collectively, antegrade single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with dorsal angulation over 45°. Appropriate puncture position helped to reduce nerve damage.

Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

“…21 She and Xu have successfully adopted the same technique as described in this study and treated fifth metacarpal neck fractures with an apex dorsal angulation of more than 45 degrees, achieving postoperative angulation of 7.4 degrees and claiming good functional and aesthetic outcomes. 7 The postoperative DASH score of their patients was 2.1± 3.6, which was not better than ours (0.3 ± 0.5).…”

“…The use of FSIN obviated the necessity of postoperative adjuvant immobilization that accompanies the use of traditional intramedullary K-wires to overcome the relative rotational instability. 7 In a systematic review comparing antegrade and retrograde intramedullary fixation of the fifth metacarpal neck fractures, the antegrade intramedullary nail fixation…”

“…Management of such fractures could be achieved through closed reduction and cast immobilization, percutaneous Kirschner (K) wire fixation, plate osteosynthesis, or transverse K-wire fixation. 7 Interfragmentary compression through lag screws alone or lag screws and neutralization plating are indicated in cases of oblique fractures when the fracture line is more than twice the length of the shaft diameter. The use of K-wires provides multiple advantages in the form of simplicity, short operative time, less invasiveness, and cost-effectiveness.…”

“…Nevertheless, K-wires provide less than optimal rotational stability of the fracture. 7 The introduction of flexible nailing has provided the hand surgeon with a versatile tool employing the principle of three-point fixation, thus allowing easy and stable reduction. Our hypothesis was that closed reduction and percutaneous fixation by flexible stable intramedullary nailing (FSIN) of metacarpal neck fractures provides a minimally invasive technique with reproducible and reliable outcomes both functionally and aesthetically.…”

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

“…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.…”