[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study

G Rivera-Saldívar; C E Rodríguez-Luna; N I Orozco-Aponte

doi:10.1016/j.recot.2023.06.013

[Translated article] Closed reduction and intramedullary fixation of fifth metacarpal neck fractures: Retrograde vs. anterograde technique. Prospective study

Rev Esp Cir Ortop Traumatol. 2023 Sep-Oct;67(5):T378-T386. doi: 10.1016/j.recot.2023.06.013. Epub 2023 Jun 25.

[Article in English, Spanish]

Authors

G Rivera-Saldívar¹, C E Rodríguez-Luna², N I Orozco-Aponte²

Affiliations

¹ Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico. Electronic address: gustavozaldivar@hotmail.com.
² Servicio de Diáfisis Traumática, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico.

PMID: 37364725
DOI: 10.1016/j.recot.2023.06.013

Abstract

Introduction: The fifth metacarpal fracture is a frequent pathology that can cause deformity and functional impairment for the adequate grip of the hand. Reintegration into daily or working activities is related to the treatment received and rehabilitation. In fractures of the neck of the fifth metacarpal, internal fixation with a Kirschner's wire is a conventional treatment method with variants that affect its outcome.

Aim of the study: To compare the functional and clinical results of the treatment of fifth metacarpal fracture with the use of retrograde vs. antegrade Kirschner wires.

Material and methods: Comparative, longitudinal, prospective study at a third-level trauma centre in patients with a fifth metacarpal neck fracture, with clinical, radiographic and Quick DASH scale follow-up at the 3rd, 6th, and 8th postoperative week.

Results: Sixty patients were included (58 men, 2 women), age of 29.63±10.15 years, with a fifth metacarpal fracture, treated by closed reduction and stabilisation with a Kirschner wire. The antegrade approach showed a metacarpophalangeal flexion range at 8 weeks of 89.11° (p<0.001; 95% CI [-26.81; -11.42]), a DASH scale value of 18.17 (p<0.001; 95% CI [23.45; 39.12]), and an average of 27.35 days to return to work (p=0.002; 95% CI [16.22; 62.14]), compared with the retrograde approach.

Conclusion: Stabilisation with antegrade Kirschner wire showed superior functional results, and metacarpophalangeal range of motion, compared to those operated via retrograde approach.

Keywords: Alambres óseos; Bone fractures; Bone wires; Fracturas; Huesos metacarpianos; Metacarpal bones; Recovery of function; Recuperación de función; Surgical procedures; Técnica quirúrgica.