Early movement does not cause loss of reduction in surgically treated boxer fractures

Abstract

Background: The surgical treatment of fifth metacarpal fractures, especially using Kirschner (K) wire techniques, has recently become popular because it provides for early hand movement. Successful anatomical reduction of the fracture is often achieved with surgery; however, an anatomical reduction cannot always be achieved and, according to 30° oblique radiography, the fracture is fixed with an apex dorsal angulation below 40°. The aim of this study was to evaluate the stability of such fractures postoperatively and compare the two different angulation options that provide early movement of the hand and wrist.

Methods: Thirty consecutive cases of neck fractures of the fifth metacarpal were treated intramedullarly with one K wire. Cases were divided into two groups: One fixed with anatomical reduction (Group 1) and the other (Group 2) fixed in apex dorsal angulation below 40°, according to 30° oblique radiography. Angulation, shortening, and functional outcome as Quick DASH scores and grip strengths were evaluated at 6 months.

Results: The mean correction angle was 56.6° (between 30° and 110°) for Group 1 and the residual angle was 0°. The mean cor-rection angle was 42.4° (between 20° and 75°) for group 2 (Figs. 4 and 5) and the residual angle was 23.6° (between 10° and 45°). The mean Quick DASH scores were 1.9 (SD: 1.7) for Group 1 and 5.67 (SD: 2.93) for Group 2 (p<0.05). Grip strength values were similar for both groups. All the patients returned to their previous occupations without any limitations in an average of 4 weeks (SD: 1.4) (range 2-6 weeks). No complications such as correction loosening or shortening were detected. Rotation was not detected during physical examination.

Conclusion: Our investigation revealed no risk of shortening or rotation of the fracture; the patients were able to return quickly to their everyday activities.

Figure 1

(a) X-ray of the case sample with fifth metacarpal neck fracture. (b) X-ray of the case sample showing that anatomical reduction and fixation can be achieved. (c) Final follow-up control X-ray of the patient sample showing that anatomical reduction can be achieved.

Figure 2

(a) X-ray of the case sample with fifth metacarpal neck fracture. (b) X-ray of the case sample showing that anatomical reduction and fixation can be achieved. (c) Final follow-up control X-ray of the patient sample in whom anatomical reduction could not be achieved.

Figure 3

(a) Clinical image of the hand at flex position. (b) X-ray of the case with K wire migration.