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McMAHON ME, Ibrahim S. Retro-Antegrade Technique in the Management of Severely Angulated Fourth and Fifth Metacarpal Neck Fractures: A Case Series. J Hand Surg Asian Pac Vol 2023; 28:685-694. [PMID: 38129762 DOI: 10.1142/s2424835523500728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background: This study introduces a novel method for the management of closed metacarpal neck fractures. Kirschner wires (K-wire) are introduced in a retrograde and the wires withdrawn through skin proximally at the base of the metacarpal. The fracture is reduced using traction and the reduction is maintained by antegrade advancement of the K-wires. The aim of this study is to report the outcomes of this technique. Methods: A total of 36 patients with severely angulated closed metacarpal neck fractures underwent reduction and fixation using this novel method from January 2017 to December 2020 in centres in Ireland and Saudi Arabia. We performed a retrospective review of these patients' clinical data examining their outcomes. Results: Six months postoperatively, all fractures demonstrated bony union and correction of angulation. All patients exhibited excellent range of motion (ROM) with no significant impairment of hand function. Conclusions: The method detailed here is a simple, minimally invasive and reliable technique that has not previously been described. It is suitable for use in the management of closed metacarpal neck fractures of the fourth and fifth metacarpal, with dorsal angulation greater than 60°. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Mary Ellen McMAHON
- Plastic & Reconstructive Surgery Department, Beaumont Hospital, Dublin, Ireland
| | - Safwat Ibrahim
- Plastic & Reconstructive Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Gu S, Zhou L, Huang Y, Xie R. The curative effect analysis of a modified Kirschner wires and locking plate internal fixation method for the fifth metacarpal neck fracture. J Orthop Surg Res 2021; 16:491. [PMID: 34384465 PMCID: PMC8359124 DOI: 10.1186/s13018-021-02627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a modified internal fixation method for the treatment of fifth metacarpal neck fracture. METHODS From March 2018 to December 2019, 12 patients with the fifth metacarpal neck fractures of the hands were treated with the Kirschner wires and locking plate internal fixation method. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, preoperative and postoperative deformity (angulation and the length of the fifth metacarpal), the range of motion of the metacarpophalangeal joint and grip strength of each side, the time of return to work, and follow-up time were recorded and calculated. RESULTS The mean follow-up time was 16.8 months, and the angulations of preoperative and postoperative deformity were 40.0 ± 3.7°and 17.6 ± 1.7°, respectively. The length of the fifth metacarpals of preoperative and postoperative deformity were 51.5 ± 2.1 mm and 60.0 ± 1.8 mm, respectively. At the last follow-up, the range of motion of the fifth metacarpophalangeal joint of the injured side and the contralateral side were 84.3 ± 3.6°and 86.5 ± 2.0°, and the grip strength of the injured side and the contralateral side were 74.8 ± 6.1 LB and 78.6 ± 8.3 LB, respectively, without statistically significant differences. QDASH score was 2.0 ± 1.0, and the time of return to work was 6.0 ± 0.7 weeks. CONCLUSION The modified internal fixation method is one of the alternative treatments for the fifth metacarpal neck fracture with good curative effects.
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Affiliation(s)
- Song Gu
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Long Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Yinjun Huang
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Renguo Xie
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
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Abstract
Metacarpal neck fractures with severe displacement are commonly treated surgically with intramedullary Kirschner wires. We present the results of treatment of fifth metacarpal neck fractures using a light curable intramedullary photodynamic polymer (IlluminOss™, IlluminOss Medical Inc., East Providence, RI, USA). Twenty-nine patients with isolated displaced fifth metacarpal neck fractures were included and followed up for 12-24 weeks. All fractures had radiologically healed after 3 months. In two cases, a secondary loss of reduction was seen, which did not require further correction. During the follow-up period, range of motion of the metacarpophalangeal joint was 89% after 6 weeks and increased to 100% after 3 months compared with the uninjured side. Grip strength improved over time from 61% to 85%. No implant removal was necessary. We conclude that osteosynthesis using an intramedullary photodynamic polymer is a reliable treatment option for displaced fractures of the fifth metacarpal neck. Level of evidence: IV.
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Affiliation(s)
- Carsten Surke
- Department of Plastic and Hand Surgery, University Hospital Bern, Bern, Switzerland
| | - Rahel Meier
- Department of Plastic and Hand Surgery, University Hospital Bern, Bern, Switzerland
| | - Luzian Haug
- Department of Plastic and Hand Surgery, University Hospital Bern, Bern, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, University Hospital Bern, Bern, Switzerland
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Eisenschenk A, Spitzmüller R, Güthoff C, Obladen A, Kim S, Henning E, Dornberger JE, Stengel D. Single versus dual Kirschner wires for closed reduction and intramedullary nailing of displaced fractures of the fifth metacarpal neck (1-2 KiWi): a randomized controlled trial. Bone Joint J 2019; 101-B:1263-1271. [PMID: 31564142 DOI: 10.1302/0301-620x.101b10.bjj-2019-0410.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.
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Affiliation(s)
- Andreas Eisenschenk
- Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Romy Spitzmüller
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claas Güthoff
- Centre for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Adrian Obladen
- Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Esther Henning
- Department of Trauma, Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jenny E Dornberger
- Burn Centre and Department of Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Dirk Stengel
- Department of Research, Business Division Medicine, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
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Sletten IN, Hellund JC, Olsen B, Clementsen S, Kvernmo HD, Nordsletten L. Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients. J Hand Surg Eur Vol 2015; 40:76-83. [PMID: 25427553 DOI: 10.1177/1753193414560119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Current literature gives few guidelines regarding indication for operative treatment of little finger metacarpal neck fractures, and some surgeons choose operative treatment when the palmar angulation exceeds 30°. The objective of this study was to determine whether conservative treatment produces comparable outcomes with bouquet pinning in a randomized, controlled trial. Eighty-five patients with little finger metacarpal neck fractures with ≥30° palmar angulation in the lateral view were included. Patients were randomized to two groups: conservative treatment without reduction of the fracture (43 patients); and closed reduction and bouquet pinning (42 patients). After 1 year, there were no statistical differences between the groups in QuickDASH score, pain, satisfaction, finger range of motion, grip strength, or quality of life. There was a trend versus better satisfaction with hand appearance (p = 0.06), but longer sick leave (p < 0.001) and more complications (p = 0.02) in the operative group.
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Affiliation(s)
- I N Sletten
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - J C Hellund
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - B Olsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - S Clementsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - H D Kvernmo
- Division of Neurosciences and Orthopaedics, University Hospital of North Norway, Tromsø, Norway Department of Clinical Medicine, University of Tromsø - Arctic University of Norway, Tromsø, Norway
| | - L Nordsletten
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Blindern, Norway
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Boussakri H, Elidrissi M, Azarkane M, Bensaad S, Bachiri M, Shimi M, Elibrahimi A, Elmrini A. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases). Pan Afr Med J 2014; 18:187. [PMID: 25419314 PMCID: PMC4237565 DOI: 10.11604/pamj.2014.18.187.3347] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 07/03/2014] [Indexed: 12/04/2022] Open
Abstract
This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture( boxers’ fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity.
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Affiliation(s)
- Hassan Boussakri
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohamad Elidrissi
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohamad Azarkane
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Soufiane Bensaad
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohammed Bachiri
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohamed Shimi
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Abdelhalim Elibrahimi
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Abdelmajid Elmrini
- Department of Orthopaedic Surgery B4, CHU Hassan II Hospital, University of Sidi Mohammed Ben Abdellah, Fez, Morocco
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