Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures

Abstract

Introduction When dealing with metacarpal neck fractures, the aim of treatment should include clinical and radiological objectives. The aim of this study was to assess the efficacy of flexible stable intramedullary nailing for the management of metacarpal neck fractures.

Materials and Methods A total of twenty four patients (22 males and 2 females; mean age: 28.2 ± 7.7 years) with metacarpal neck fractures (second in 7 patients and fifth in 17 patients) whether isolated or associated with other body injuries and managed by percutaneous flexible stable intramedullary nailing were reviewed for a retrospective case series. Personal interviews were conducted together with clinical and radiological assessments. The final results were recorded at the time of personal interviews.

Results The mean duration of surgery was 19.3 ± 2.5 minutes. The mean time of radiological union was 5 ± 1.3 weeks. The mean postoperative active range of motion of the metacarpophalangeal joint was 102.4 ± 11 degrees. The mean supination power of the involved hand in comparison to the contralateral side was 97.8 ± 3.4%, whereas the pronation power percentage was 99.2% ± 1.6. The mean power grip percentage to the contralateral side was 96.4 ± 2.9%, whereas the mean percentage of the pinch grip was 96.1 ± 4.2%. The mean postoperative DASH (Disability of Arm, Shoulder, and Hand) score was 0.3 ± 0.5.

Conclusion Percutaneous flexible stable intramedullary nailing for the treatment of metacarpal neck fractures has expanded the armamentarium of the orthopaedic surgeons as an easy, cost-effective technique overcoming all possible deformities and allowing early and reliable active rehabilitation.

Level of Evidence This is a Type IV, therapeutic retrospective case series.

Keywords

flexible nailing - metacarpal neck fractures - percutaneous - three-point fixation

Publication History

Article published online:
10 November 2019

• References

• 1 Potenza V, Caterini R, De Maio F, Bisicchia S, Farsetti P. Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning. Injury 2012; 43 (02) 242-245
• 2 Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am 2006; 31 (07) 1068-1074
• 3 Zong SL, Zhao G, Su LX. et al. Treatments for the fifth metacarpal neck fractures: a network meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95 (11) e3059
• 4 Harris AR, Beckenbaugh RD, Nettrour JF, Rizzo M. Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand (N Y) 2009; 4 (02) 161-164
• 5 Polat O, Cömert A, Atalar H, Açar HI, Tüccar E. Safe percutaneous pinning for subcapital fifth metacarpal fractures: an anatomical study. Acta Ortop Bras 2011; 19 (02) 106-109
• 6 Opgrande JD, Westphal SA. Fractures of the hand. Orthop Clin North Am 1983; 14 (04) 779-792
• 7 She Y, Xu Y. Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing. BMC Musculoskelet Disord 2017; 18 (01) 238
• 8 Balfour GW. Minimally invasive intramedullary rod fixation of multiple metacarpal shaft fractures. Tech Hand Up Extrem Surg 2008; 12 (01) 43-45
• 9 Jhass S. Fractures of the metacarpals: a new method of reduction and immobilization. J Bone Joint Surg 1938; 20 (01) 178-186
• 10 Hardy MA. Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts. J Orthop Sports Phys Ther 2004; 34 (12) 781-799
• 11 Lazenby RA. Second metacarpal midshaft geometry in an historic cemetery sample. Am J Phys Anthropol 1998; 106 (02) 157-167
• 12 Lazar G, Schulter-Ellis FP. Intramedullary structure of human metacarpals. J Hand Surg Am 1980; 5 (05) 477-481
• 13 Plato CC, Garruto RM, Yanagihara RT. et al. Cortical bone loss and measurements of the second metacarpal bone. I. Comparisons between adult Guamanian Chamorros and American Caucasians. Am J Phys Anthropol 1982; 59 (04) 461-465
• 14 Strauch RJ, Rosenwasser MP, Lunt JG. Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am 1998; 23 (03) 519-523
• 15 Foucher G. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995; 20 (3 Pt 2) S86-S90
• 16 Orbay J. Intramedullary nailing of metacarpal shaft fractures. Tech Hand Up Extrem Surg 2005; 9 (02) 69-73
• 17 Ferreira GP, Pires PR, Portugal AL, Schneiter HdeG. Intra-focal reduction and percutaneous fixation of neck fractures of the fifth metacarpal: description of surgical technique. Rev Bras Ortop 2014; 49 (02) 116-120
• 18 Paul AS, Kurdy N, Kay PR. Fixation of closed metacarpal shaft fractures. Transverse K-wires in 22 cases. Acta Orthop Scand 1994; 65 (04) 427-429
• 19 Sletten IN, Nordsletten L, Husby T, Ødegaard RA, Hellund JC, Kvernmo HD. Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. J Hand Surg Eur Vol 2012; 37 (05) 387-395
• 20 Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: locking plate versus K-wire?. Orthop Traumatol Surg Res 2010; 96 (05) 506-512
• 21 Yammine K, Harvey A. Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2014; 24 (03) 273-278
• 22 Root CG, London DA, Schroeder NS, Calfee RP. Anatomical relationships and branching patterns of the dorsal cutaneous branch of the ulnar nerve. J Hand Surg Am 2013; 38 (06) 1131-1136
• 23 Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29 (04) 689-693