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.

Keywords: Boxer's fracture; Metacarpal neck fracture; intramedullary nailing; minimally invasive..

Figure 1

Jahss maneuver

Figure 2

Kirschner wire (K-wire), pre-bent in a lazy-S fashion

Figure 3

The rotational displacement of the fifth ray

Figure 4

(e,f): Radiograph of a 28 years old male patient with displaced little finger metacarpal neck fracture; (g,h): Postoperative radiograph of the same patient treated with intramedullary nailing

Figure 5

Radiological evidence of satisfactory outcome after removal of the wire of the same patient as show in Figure 4

Figure 6

Examination shows perfect healing of the fracture without malrotation or volar angulation of the metacarpal head and a good functional results at 1 year followed-up of the same patient as show in Figure 4, Figure 5

Figure 7

One case as the wire had backed out loosing the reduction at the fracture site