Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures: Closed Reduction and Fixation Using Either an Open Antegrade or Percutaneous Retrograde Technique.

Abstract

Although the majority of fifth metacarpal neck fractures can be treated nonoperatively, surgery may be indicated when there is severe shortening or angulation of the metacarpal bone¹. Proper positioning of the image intensifier and the treating surgeons is important. Prepare and bend the Kirschner wires before insertion. Create a hole for Kirschner wire insertion in the center of the fifth metacarpal base. Insert the Kirschner wires through the hole of the fifth metacarpal base. An additional skin incision is necessary to remove the Kirschner wires after bone union. Proper positioning of the image intensifier and treating surgeon is important. Reduce the fifth metacarpal neck fracture using the Jahss maneuver. Fix the reduced metacarpal neck fracture using 2 Kirschner wires placed percutaneously in a retrograde direction, with the second wire inserted after the first wire passes the fracture site but before it passes the metacarpal base. The proximal end of the Kirschner wire penetrating outside the dorsal skin of the wrist enables the surgeon to percutaneously retrieve the Kirschner wire after fracture union. The percutaneous Kirschner wire is retrieved. In a previous prospective randomized analysis of patients treated with antegrade intramedullary pinning and percutaneous retrograde intramedullary pinning for displaced fifth metacarpal neck fracture¹, we found that the flexion arc of the MCP joint, visual analog pain scale score, grip strength, and DASH (Disabilities of the Arm, Shoulder and Hand) score⁴ were significantly better in the antegrade intramedullary pinning group at 3 months postoperatively.