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. 2017 Apr 28;88(1):57-64.
doi: 10.23750/abm.v88i1.6195.

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing

Francesco Pogliacomi  1 , Elisabetta Mijno, Alesssio Pedrazzini, Silvio Tocco, Massimo Tonani, Francesco Ceccarelli, Enrico Vaienti
Affiliations

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing

Francesco Pogliacomi et al. Acta Biomed. .

Abstract

Background: Fifth metacarpal neck fractures (commonly named "boxer's fractures") are the most common metacarpal injuries and usually affect young active people. These lesions are mainly treated conservatively. Their surgical management, if indicated, is still a matter of debate. Different procedures have been described. The aim of this study was to evaluate the outcomes of 18 boxer's fractures which were synthesized with antegrade locked flexible intramedullary nailing.

Materials and methods: All patients, at a mean follow-up of 45 months, were clinically evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Patient Rated Wrist/Hand Evaluation (PRWHE). Active and passive range of motion (ROM) of metacarpo-phalangeal (MP), proximal and distal interphalangeal (PIP and DIP) joints and Total Active Motion (TAM), and grip strength were also analyzed. Apex dorsal angulation and axial shortening were radiologically measured preoperatively and at final follow-up.

Results: Clinical and radiological results which were observed were satisfactory. No TAM and grip strength differences were recorded between the operated and healthy contralateral hand.

Conclusions: According to the positive outcomes and the low rate of complications of this study, antegrade locked flexible intramedullary nailing can be considered a valid treatment option in boxer's fractures.

Keywords: boxer's fracture, metacarpal, neck, osteosynthesis, intramedullary nailing.

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Figures

Figure 1
Figure 1
Fifth metacarpal neck fracture of the left hand. Preoperative radiographs (A) and x-rays after closed reduction and application of a splint (unsatisfactory result) (B). Postoperative views (C) and after removal of the nail (D). Satisfactory clinical outcome (E)
Figure 2
Figure 2
Fifth metacarpal neck fracture of the right hand with fragmentation of the volar cortex. Preoperative radiographs (A) and x-rays after closed reduction and application of a splint (unsatisfactory result) (B). Postoperative views (C) and after removal of the nail (D). Satisfactory clinical outcome (E).
See this image and copyright information in PMC

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