Closed reduction and intramedullary fixation using Kirchner wires and plate osteosynthesis in the treatment of fractures of distal end of fifth metacarpal bone
Authors:
Robert Manek; Martin Vlček; Jaroslav Kalvach; Ivan Landor
Authors‘ workplace:
1. Ortopedická klinika 1. lékařské fakulty UK Praha a FN v Motole
; st Orthopaedic Clinic of First Faculty of Medicine of Charles University in Prague and Motol University Hospital, Prague, Czech Republic
1
Published in:
Úraz chir. 24., 2016, č.3
Overview
Objective:
To compare the therapeutic results of closed reduction with intramedullary stabilization using Kirschner wires and fixation with locking plates in the treatment of fractures of the distal part of the fifth metacarpal bone.
Material and methods:
Group “KDR” includes 14 patients with fractures of the head and neck of the fifth metacarpal treated by closed reduction and retrograde inserion of Kirschner wires. “APT” group contains 16 patients with the same fracture types treated by open reduction from a dorsolateral approach and stabilization by Aptus locking plates.
Results:
In the KDR group all fractures healed, but in five cases (35.7 %) the position of the bone fragments was unsatisfactory. In the APT group the fractures healed in 15 cases (93.8 %), in one patient (6.3 %) partial necrosis of the head of the fifth metacarpal occurred. In two cases (12.5 %) in the APT group there was healing in unsatisfactory fragment position. In the KDR group full flexion in the metacarpophalangeal joint was achieved in 9 patients (64.3 %) and in APT group in 14 cases (87.5 %). In two cases (14.2 %) in the KDR healing in rotational malposition of peripheral fragment was observed, while in the APT group this complication did not occur.
Conclusion:
In the tratment of fifth metacarpal head and neck fracture, the advantage of plate osteosynthesis is the ability to achieve precise anatomic reduction, which is the basis for good functional outcome. In the case of stabilization by Kirchner wires healing in rotational malposition of the peripheral fragment may occur more frequently since this deviation is not evaluable on X-rays.
Keywords:
Fifth metacarpal, fracture, angle stable plate, Kirschner wire.
Sources
1. ALI, A., HAMMAN, J., MASS, DP. The biomechanical effects of angulated boxer‘s fractures. J Hand Surg Am. 1999, 24, 835–844. ISSN 1793-6535
2. BOUSSAKRI, H., ELIDRISSI, M., AZARKANE, M. et al. 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. ISSN 1937-8688
3. DOARN, MC, NYDICK, JA, WILLIAMS, BD. et al. Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results. Hand (N Y). 2015,10, 314–318. ISSN 1558-9447
4. FACCA, S., RAMDHIAN, R., PELISSIER, A. et al. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? Orthop Traumatol Surg Res. 2010, 96, 506–512. ISSN 1877-0568
5. FOUCHER, G. „Bouquet“ osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995, 20, 86–90. ISSN 1793-6535
6. GUDMUNDSEN, TE., BORGEN, L. Fractures of the fifth metacarpal. Acta Radiol. 2009, 50, 296–300. ISSN 0284-1851
7. HANNA, WA., LAIER, P. Hand injuries from combat sports. Unfallchirurg. 2015, 118, 507–514. ISSN 0177-5537
8. HARRIS, AR., BECKENBAUGH, RD., NETTROUR, JF. et al. Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand (N Y). 2009, 4,161–164. ISSN 1558-9447
9. JHASS, S. Fractures of the metacarpals – a new method of the reduction and immobilization. J Bone Joint Surg. 1938, 2, 178–186. ISSN 1535-1386
10. JONES, R., BURDETT, S., JEFFERIES, M. et al. Treating the boxer‘s fracture in Wales: a postal survey. Ann R Coll Surg Engl. 2010, 92, 236–239. ISSN 0035-8843
11. KARL, JW., OLSONM PR., ROSENWASSER, MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma. 2015; 29: e242–244. ISSN 0890-5339
12. KEENAN, M. Managing boxer‘s fracture: a literature review. Emerg Nurse. 2013, 21, 18–24. ISSN 1755-599X
13. MARZOUKI, A., ELMRINI, A., ELIBRAHIMI, A. et al. Vives pinning in L of the fractures of the fifth metacarpal neck-24 cases. Chir Main. 2009, 28, 78–81. ISSN 1297-3203
14. MOHAMMED, R., FAROOK, MZ., NEWMAN, K. Percutaneous elastic intramedullary nailing of metacarpal fractures: surgical technique and clinical results study. J Orthop Surg Res. 2011, 6, 37. ISSN 1749-799X
15. MCNEMAR, TB., HOWELL, JW., CHANG, E. Management of metacarpal fractures. J Hand Ther. 2003,16, 143–151. ISSN 0894-1130
16. PILNÝ, J., SLODIČKA, R. Chirurgie ruky. Praha: Grada, 2011. 400 s. ISBN 978-80-247-3295-4
17. POTENZA, V., CATERINI, R., DE MAIO, F. et al. Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning. Injury. 2012, 43, 242–245. ISSN 0020-1383
18. SLETTEN, IN., HELLUND, JC., OLSEN, B. et al. 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. 2015, 40, 76–83. ISSN 1753-1934
19. TAŞBAŞ, BA., OZAKPINAR, HR., DELIALIOĞLU, MO. et al. Real angulation degree in fifth metacarpal neck fracture. Eklem Hastalik Cerrahisi. 2011, 22, 85–88. ISSN 1305-8282
20. WINTER, M., BALAGUER, T., BESSIÈRE, C. et al. Surgical treatment of the boxer‘s fracture: transverse pinning versus intramedullary pinning. J and Surg Eur. 2007, 32, 709–713. ISSN 1753-1934
21. WONG, KP., HAY, RA., TAY, SC. Surgical outcomes of fifth metacarpal neck fractures-a comparative analysis of dorsal plating versus tension band wiring. Hand Surg. 2015, 20, 99–105. ISSN 0218-8104
22. ZHANG, X., HUANG, X., SHAO, X. Reduction of fifth metacarpal neck fractures with a Kirschner wire. J Hand Surg Am. 2015, 40, 1225–1230. ISSN 1793-6535
Labels
Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/b273cd9e43802857084d2bd281a79235.jpeg)
2016 Issue 3
Most read in this issue
- Comparsion of treatment methods and complitacions in pilon fractures of the tibia
- Closed reduction and intramedullary fixation using Kirchner wires and plate osteosynthesis in the treatment of fractures of distal end of fifth metacarpal bone
- Surgery in the early post-trauma period in patients with triage positive injuries
- Injuries of the Diaphragm