Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases)

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.

Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review

“…The wire is driven antegradely into the medullary canal. The study reported that at the final follow-up, there was no evidence of rotational or angulation deformity [29].…”

New fixation approach for transverse metacarpal neck fracture: a biomechanical study

“…Metacarpal fractures are common orthopedic injuries [ 1 ] that account for 13% of hand fractures and 23% of forearm fractures [ 2 – 4 ]. The fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common type of metacarpal fracture, constituting 50% of metacarpal fractures [ 2 ]. Because of the activity performed by the intrinsic muscles of the hand, patients with fractures in the fifth metacarpal neck are likely to develop volar angulation deformity.…”

Emergency and Trauma of Hand and Wrist

“…The fifth and fourth metacarpals are most frequently injured. A subcapital fracture with volar angulation, or "boxer's fracture" (mainly subsequent to an incorrectly placed punch), is the most common metacarpal fracture 99,101 (►Fig. 10).…”