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Suhail D, Ma Y, Chung P, Al-Ani S, Jester A. Management of paediatric fifth metacarpal neck fractures: a systematic review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05393-4. [PMID: 38824459 DOI: 10.1007/s00402-024-05393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. METHODS PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. RESULTS Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. CONCLUSIONS This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.
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Affiliation(s)
| | - Yangmyung Ma
- Hand and Upper Limb Service, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK.
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, UK.
| | | | - Sami Al-Ani
- Aston Medical School, Birmingham, B4 7ET, UK
| | - Andrea Jester
- Hand and Upper Limb Service, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
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Wang K, Du W, Deng C, Hu N, Zhuang W. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. J Int Med Res 2023; 51:3000605231174981. [PMID: 37243605 DOI: 10.1177/03000605231174981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
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.
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Affiliation(s)
- Kai Wang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Weibin Du
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Changzong Deng
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Ningrui Hu
- Hubei Chinese Medical University, Wuhan, China
| | - Wei Zhuang
- Research Institute of Orthopedics, the Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
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Haddad E, Zemour M, Belkacemi Y, Al Khoury Salem H, Dohin B. L-pinning for fifth metacarpal neck fracture in adolescents. Orthop Traumatol Surg Res 2022; 108:102992. [PMID: 34186217 DOI: 10.1016/j.otsr.2021.102992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpals. The present study aimed to assess L-pinning without postoperative immobilization in displaced 5th metacarpal fracture in adolescents with low residual growth. MATERIALS AND METHODS Data for patients aged between 13 and 16 years, operated on for closed 5th metacarpal neck fracture between January 2017 and June 2019, were analyzed retrospectively. Surgery was indicated for angulation with>30° palmar tilt and/or horizontal malalignment. The technique consisted in intramedullary anterograde pinning and transverse pinning between the 4th and 5th metacarpal heads. No postoperative immobilization was applied. Hardware was removed as of day 28. The final clinical check-up was at≥12 months. RESULTS Eighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm2. At hardware removal, all patients showed radiologic consolidation. At 3 months, 5th ray ranges of motion were normal, with no local complications. Functional results were maintained at last follow-up (≥12 months). CONCLUSION L-pinning seemed reliable in terms of feasibility and stability of reduction in 5th metacarpal neck fracture in adolescents. Absence of postoperative immobilization facilitated self-rehabilitation and accelerated functional recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elie Haddad
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France.
| | - Marion Zemour
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Yacine Belkacemi
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Hassan Al Khoury Salem
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France
| | - Bruno Dohin
- Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France; LIBM (Laboratoire Interuniversitaire de Biologie du Mouvement, Université Jean Monnet, Université de Lyon.), Saint Etienne, France
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Fan XL, Wang J, Zhang DH, Mao F, Liao Y, Xiao R. Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth. BMC Musculoskelet Disord 2021; 22:546. [PMID: 34130660 PMCID: PMC8204464 DOI: 10.1186/s12891-021-04436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04436-w.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.,Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Jian Wang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - De-Hua Zhang
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Feng Mao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China
| | - Yi Liao
- Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
| | - Rui Xiao
- Department of Surgical Center, Karamay Central Hospital of Xinjiang, 834000, Karamay, China. .,Karamay District Center for Disease Control and Prevention , 834000, Karamay, China.
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Assi C, Mansour J, Samaha C, Ajjoub S, Yammine K. A single antegrade intramedullary k-wire for fifth metacarpal neck fractures. Eur J Trauma Emerg Surg 2019; 46:389-395. [PMID: 30617399 DOI: 10.1007/s00068-018-01073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Antegrade intramedullary nailing (AIMN) using 2k-wires seems to be superior to other modalities in treating displaced fractures of the fifth metacarpal neck (FFMN). Few reports demonstrated similar results retrospective with a single k-wire. The aim of the study is to describe our single k-wire technique and evaluate the related results. METHODS This is a retrospective study of a continuous series of patients treated with a single intramedullary k-wire for FFMN. It includes 30 patients who met the criteria for surgery: a dorsal angulation of more than 30°, malrotation, or both. The mean clinical follow-up period was 7 ± 14.9 months. RESULTS The mean pre-operative angle was 50° ± 11.35° and the mean immediate post-operative angle was 4.86° ± 2.8°. The mean immediate correction was 47° ± 9.3°. The mean correction at last follow-up was 45.14° ± 8.55°. Healing was obtained in all patients and bone union was achieved at a mean of 5.6 ± 1.2 weeks. The mean operative time was 8.5 min. The mean C-arm usage (number of clicks) was 7.2 times. The mean exposure radiation time was calculated at 3.6 s. The mean radiation dose was 0.08 mGy/mm2. The mean satisfaction score was 1.26 ± 0.45. Quick-DASH and EQ-5D scores yielded excellent values. CONCLUSIONS With potential benefits like lesser surgical time, radiation and cost, the use of a single AIMN could be safer, quicker and cheaper while reproducing similar clinical, functional and radiological outcomes to those reported with the use of 2k-wires.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Sleiman Ajjoub
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafieh, Beirut, Lebanon.
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Antegrade Percutaneous Intramedullary Fixation Technique for Metacarpal Fractures: Prospective Study on 150 Cases. Tech Hand Up Extrem Surg 2018; 22:104-109. [PMID: 29889155 DOI: 10.1097/bth.0000000000000198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible. MATERIAL AND METHODS Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013. A total of 150 patients with 165 metacarpal fractures were evaluated until February 2016. Average follow-up duration was 10 weeks. The clinical outcome was assessed by the total active motion of the digit, presence of rotational deformity, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Patient-Rated Wrist/Hand Evaluation (PRWHE) score. The radiographic outcome was assessed by evaluating the dorsal angulation and shortening of the metacarpal, comparing the postoperative radiography and the first radiography showing fracture healing. RESULTS Comparing the injured and contralateral digit average total active motion after 10 weeks from surgery, no statistical significance emerged. No patient developed extensor tendon irritation, so that there was no need to perform tenolysis, ever. The average Quick Disabilities of the Arm, Shoulder, and Hand score was 12.3 (range, 0 to 37). The average Patient-Rated Wrist/Hand Evaluation score was 19 (range, 0 to 41). Fracture union was steadily achieved. Radiographic assessment showed a nonsignificant postoperative loss of reduction. CONCLUSIONS Antegrade intramedullary K-wire fixation technique is valid, reproducible, cheap, and perfectly suited to the treatment of metacarpal fractures requiring surgery, providing immediate mobilization and excellent outcomes for a very wide variety of fractures.
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