Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and meta-analysis

Abstract

Purpose: We investigated the outcomes of the antegrade intramedullary nailing (AIMN) compared to other surgical modalities in the treatment for fifth metacarpal neck fractures via a systematic review.

Methods: Pain, functional scores, grip strength, total active motion (TAM), the range of motion (ROM) of the fifth metacarpal joint, complications and patient satisfaction were set to be the primary outcomes. The data were evaluated using a modified version of the Cochrane Collaboration tool.

Results: We identified four studies, comprising 163 participants, which met the inclusion criteria. Meta-analyses showed that (a) AIMN demonstrated significantly better results in relation to GS at 12 months (p < 0.0001), TAM (p = 0.01) and ROM of the fifth finger (p = 0.0001); (b) AIMN technique yielded significantly lesser residual angulation at the site of fracture (p = 0.05); (c) AIMN significantly demonstrated fewer complications (p = 0.05); (d) there was a trend for better pain scores when using AIMN.

Conclusions: Though the amount of evidence was derived from just four small sample-sized studies, our findings suggested that the AIMN technique could have some advantages over the use of plates or other types of pinning in the treatment for the fifth metacarpal neck fractures. We highlighted the need for a standardization of the outcomes and their corresponding units related to this specific type of fracture. Editors and reviewers should incite authors to provide the standard deviation values for the reported means.

Level of evidence: Therapeutic II.