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. 2017 Jun 2;18(1):238.
doi: 10.1186/s12891-017-1592-3.

Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing

Yuanshi She  1 , Youjia Xu  2
Affiliations

Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing

Yuanshi She et al. BMC Musculoskelet Disord. .

Abstract

Background: The aim of this study was to investigate clinical outcomes of fifth metacarpal neck fractures using antegrade single elastic nail and to explore ideal puncture point to avoid iatrogenic ulnar nerve injury.

Methods: A single elastic nail with suitable diameter was used in 27 cases of fifth metacarpal neck fractures with dorsal angulation over 45°. An initial entry point was perforated at the ulnar-dorsal base of the metacarpal. The nail was inserted in an antegrade approach. The nail was usually removed at about 5 weeks postoperatively.

Results: At final follow up, all fractures proceeded to bony union. The mean total passive motion was 285° and the mean total active motion (TAM) was 270°. The mean angulation decreased from 50.2 ± 6.3° preoperatively to 7.4 ± 2.3° postoperatively (p < 0.001). The mean DASH-Score was 2.1 ± 3.6 points after surgery. Two cases of skin irritation and one case of the dorsal cutaneous branch of the ulnar nerve (DCBUN) injury were observed. Superficial wound infections were not observed.

Conclusions: Collectively, antegrade single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with dorsal angulation over 45°. Appropriate puncture position helped to reduce nerve damage.

Keywords: Antegrade single elastic nailing; Fracture; Metacarpal neck; Surgery.

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Figures

Fig. 1
Fig. 1
Typical fifth metacarpal neck fracture is shown preopepratively in the anteroposterior (a) and latero-oblique (b) planes with apex dorsal angulation 49.7degrees
Fig. 2
Fig. 2
The fracture is treated with antegrade single ESIN achieving axial alignment in the anteroposterior (a) and latero-oblique (b) planes (with the distal of the nail dorsally)
Fig. 3
Fig. 3
Status after the plant removal are shown (a-c).
See this image and copyright information in PMC

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