Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

Facca, S.; Ramdhian, R.; Pélissier, A.; Diaconu, M.; Liverneaux, Philippe

doi:10.1016/j.otsr.2010.02.009

Cited by 98 publications

(130 citation statements)

References 16 publications

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“…This finding is in line with those of previous studies regarding fracture reductions (assessed by apex dorsal angulation and shortening) achieved by antegrade intramedullary pinning and other surgical methods, such as percutaneous transverse pinning [19,20], miniplate [4,6], and percutaneous retrograde crossed pinning [16].…”

Section: Discussionsupporting

confidence: 92%

“…However, Schädel-Höpfner et al [16], in a randomized study, compared the outcomes of antegrade intramedullary pinning and percutaneous retrograde crossed pinning for displaced fifth metacarpal neck fractures and found that antegrade intramedullary pinning produced better ROM, pain scores, and Steel scores (a score comprised of pain, ROM, grip strength, and radiographic deformity) in the fifth metacarpophalangeal joint after a mean patient followup of 17 months. Facca et al [4], in a randomized study, compared the outcomes of antegrade intramedullary pinning and the locking miniplate technique for treating patients with displaced fifth metacarpal neck fractures and also found antegrade intramedullary pinning produced significantly better ROM in the metacarpophalangeal joint after a mean followup of 4 months. Yammine and Harvey [21], in a meta-analysis, concluded that patients treated with antegrade intramedullary pinning showed better grip strength, fifth digit ROM, lower pain scores, and fewer complications than patients treated with percutaneous transverse pinning or miniplate.…”

Section: Discussionmentioning

confidence: 99%

“…Although the majority of these fractures can be treated nonoperatively, surgery may be indicated when there is shortening of the metacarpus by more than 3 mm or when severe apex-dorsal angulation is present [4,6,16,[18][19][20][21]. It remains controversial how much angulation can be tolerated without loss of hand function or hand pain [18].…”

Section: Introductionmentioning

confidence: 99%

“…Several surgical techniques have been used to treat displaced fifth metacarpal neck fractures, including antegrade intramedullary K-wire, retrograde intramedullary K-wire, retrograde cross pinning with K-wire, transverse pinning with K-wire, external fixation, intraosseous wiring, and plate fixation [4,6,16,[18][19][20][21]. Since Foucher et al [5] described the antegrade intramedullary K-wire technique, it has been widely used and produces reliable fracture reduction and excellent ROM of the fifth finger for patients with a fifth metacarpal neck fracture [4,6,16,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…Since Foucher et al [5] described the antegrade intramedullary K-wire technique, it has been widely used and produces reliable fracture reduction and excellent ROM of the fifth finger for patients with a fifth metacarpal neck fracture [4,6,16,20,21]. The retrograde intramedullary K-wire technique initially was advocated by Lord [13], and after introduction of the intraoperative C-arm, the retrograde intramedullary K-wire technique was modified to enable extraction of the end of the wire proximally and bending of the wire dorsally using a percutaneous technique [15].…”

Section: Introductionmentioning

confidence: 99%

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Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures

Kim

2015

Clinical Orthopaedics &Amp; Related Research

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Background Severe angulation or shortening can be a surgical indication for fifth metacarpal neck fracture. In a previous meta-analysis, antegrade intramedullary pinning was shown to produce better hand function outcomes than percutaneous transverse pinning or miniplate fixation for treatment of fifth metacarpal neck fractures. However, the outcomes of retrograde intramedullary pinning, to our knowledge, have not been compared with those of antegrade intramedullary pinning. Questions/purposes We asked whether the clinical and radiographic outcomes of antegrade intramedullary pinning are different from those of percutaneous retrograde intramedullary pinning for treating patients with displaced fifth metacarpal neck fractures. Methods Forty-six patients with displaced fifth metacarpal neck fractures with an apex dorsal angulation greater than 30°were enrolled in our prospective study. Subjects were treated randomly by antegrade intramedullary pinning (antegrade group) or by percutaneous retrograde intramedullary pinning (retrograde group). Clinical evaluations, which included active ROM of the fifth metacarpophalangeal joint, VAS for pain, grip strength, and DASH score, were performed at 3 months and 6 months postoperatively. Radiographic evaluations of apex dorsal angulation and axial shortening were performed preoperatively and 6 months postoperatively. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusion Our study findings suggest antegrade intramedullary pinning has some clinical advantages during the early recovery period over percutaneous retrograde intramedullary pinning for treatment of displaced fifth metacarpal neck fractures, but the advantages are not evident at 6 months postoperatively. In addition, our study showed no differences in radiographic outcomes between antegrade and retrograde techniques. For patients who require an early return of hand function, such as athletes, antegrade intramedullary pinning can be recommended. Otherwise, treatment could be decided according to the surgeon's preference and patient status, and based on consideration of the need for an accessory procedure for pin removal after antegrade intramedullary pinning. Level of Evidence Level I, therapeutic study.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures

Kim

2015

Clinical Orthopaedics &Amp; Related Research

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Morphometric analysis of the second through fifth metacarpal through posteroanterior X‐Rays

et al. 2019

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Over the past 10 years, metacarpal fractures have had an annual incidence of 13.6 per 10,000 individuals. Literature has not reviewed anatomical variations through radiographic imaging, which may play a role in reducing postoperative complications. The purpose of this study was to use radiographic imaging to provide a detailed anatomy of the second through fifth metacarpals. This retrospective study measured length, neck width, narrowest body width, and narrowest medullary canal width of the second through fifth metacarpals through the use of posteroanterior X‐rays. Patients who were ≥18 years and received hand radiographs from January 2015 to July 2019 were included in this study. Those with acute injury or fracture of the metacarpal were excluded. Five hundred and seventy‐two metacarpals were included in this study, with 143 metacarpals measured each for the second through fifth metacarpal. The second metacarpal had the largest measured length, neck width, and narrowest body width at 68.72, 12.34, and 8.74 mm, respectively. The fifth metacarpal had the greatest average medullary canal width at 4.15 mm. This is the largest study in literature to comprehensively examine the anatomical variation of the second through fifth metacarpals. The second metacarpal had greatest dimensions except for canal width, which was the fifth metacarpal. Men almost consistently had greater metacarpal size when compared to women, and age was associated with second and third metacarpal canal width. The increased knowledge of metacarpal anatomy may potentially lay the foundation of further improvement of metacarpal implants and potentially reduce postoperative complications. Clin. Anat., 33:1014–1018, 2020. © 2019 Wiley Periodicals, Inc.

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Injury-Fractures-Carpo-Metacarpal Joint and Metacarpal

Hayton

2014

Disorders of the Hand

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Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

Abstract: Level IV continuous prospective comparative study.

Cited by 98 publications

References 16 publications

Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures

Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures

Morphometric analysis of the second through fifth metacarpal through posteroanterior X‐Rays

Injury-Fractures-Carpo-Metacarpal Joint and Metacarpal

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