Analysis of three minimally invasive methods in the treatment of the fifth metacarpal neck fracture / 中国骨伤

OBJECTIVE@#To explore the effective method of applying Chinese medicine manipulative repositioning Kirschner wire fixation for minimally invasive treatment of fractures of the neck of the fifth metacarpal.@*METHODS@#From January 2018 to November 2021, 90 patients with closed fractures of the neck of the fifth metacarpal bone were treated minimally invasively with closed repositioning Kirschner wires, all fractures AO type was type A. All patients were divided into three groups according to the mode of internal fixation involving 30 cases in the crossed Kirschner's wire group, 30 cases in the transverse Kirschner's wire group, 30 patients in the intramedullary Kirschner's wire group. By comparison, gender, age, disease duration, and preoperative neck-stem angle were not significant. The postoperative fifth metacarpal neck-stem angles, postoperative fifth metacarpophalangeal joint flexion mobility and fifth metacarpophalangeal joint extension hyperextension angles were compared among three groups. The overall clinical efficacy was evaluated according to the patient outcomes of surgery-hand/arm(POS-Hand/Arm) scoring system.@*RESULTS@#All patients had 12-month follow-up and achieved bony union without malunion. There was no significant difference in the 5th metacarpal neck-stem angle, the fifth metacarpophalangeal joint flexion angle and the fifth metacarpophalangeal joint extension hyperextension angles among three groups at 12 months after surgery(P>0.05). There was no significant difference in physical activity and symptom scores in POS-Hand/Arm scores at 12 months after surgery(P>0.05), psychological status and aesthetic score among three groups(P<0.05) and between cross and transverse Kirschner wire groups(P>0.05). The three POS-Hand/Arm total scores were statistically different(P<0.05), between the crossed and transverse(P>0.05), and the intramedullary group had the highest POS-Hand/Arm scores.@*CONCLUSION@#All three techniques of Kristener's wire fixation could achieve minimally invasive treatment, and patients have need for cosmetic and early activity, and the author recommend minimally invasive intramedullary fixation with manipulative repositioned Kristen wires as the preferred procedure.

Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-six Fractures

@#Introduction:Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results:The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.

Treatment of Metacarpal Fractures using Transverse Kirschner-wire Fixation / 대한정형외과학회잡지

PURPOSE: To analyze the clinical results of transverse Kirschner (K)-wire fixation for metacarpal fractures. MATERIALS AND METHODS: Between May 2002 and May 2005, thirty-four cases (thirty-nine fingers) of unstable metacarpal fractures underwent a closed reduction and transverse K-wire fixation. The neck, shaft and base fractures of the metacarpals except the thumb were included. The follow-up period ranged from 12 months to 3 years and 4 months (mean; 2 years and 1 month). Interfragmentary fixation was performed on 24 cases. A short arm splint was maintained until postoperative 4 weeks, after which the full range of motion was permitted. The K-wires were removed after achieving the full-range of motion or pin-site infection. RESULTS: At the last follow-up, there was no limitation of motion and discomfort during the daily living activities. Five cases had skin problems around the tip of the K-wire. All cases, except for three cases with angulation over 20 degrees, had achieved the union under five degrees (average 3.24 degrees dorsal angulation). Three cases had minimal rotational deformities but they did not complain of discomfort. The one case of nonunion, in whom the K-wires had been removed four weeks after surgery, underwent plate fixation and a bone graft. CONCLUSION: Transverse K-wire fixation and additional interfragmentary fixation of the metacarpal fractures can allow the full range of motion without the need to remove the K-wires. The clinical results were excellent.

Treatment of Metacarpal Shaft Fractures with Plates and Screws / 대한정형외과학회잡지

PURPOSE: The objective of this study was to evaluate the clinical results of internal fixation using plates and screws or screws only for the treatment of unstable metacarpal fractures. MATERIALS AND METHOD: We retrospectively reviewed the clinical and radiologic records of 21 patients with 23 metacarpal fractures treated by open reduction and internal fixation with plates and screws or with screws only from Nov. 1999 to Sep. 2001. 1.5 mm plates and screws were used in 9 cases, 1.7 mm plates and screws in 6 cases and 2.0 mm plates and screws in 7 cases; a 2.7 mm plate and screw was used in one patient with a large metacarpal. The average follow-up period was 15 months. To assess the results, the range of motion, complications and radiographic findings were investigated. RESULTS: The mean period of bone union was 8.5 weeks. Most patients had regained a full range of motion at last follow-up and there was no evidence of rotational deformity or shortening. Complications were plate breakage in 1 case, delayed union in 1 case and dorsal angulation in 3 cases. CONCLUSION: Internal fixation using plates and screws is considered to be a useful method of providing anatomical reduction, and to allow early motion in the treatment of unstable metacarpal fractures.