Comparison of Conservative and Closed Reduction Percutaneous Pinning Methods for the Treatment of 5th Metacarpal Neck Fractures

Abstract

Introduction: This study aimed to evaluate the clinical and radiological outcomes of conservative treatment and closed reduction with anterograde pinning for the treatment of 5th metacarpal (MC) neck fractures. Methods: Data of patients who underwent surgery for 5th MC neck fractures between January 2017 and December 2020 were retrospectively analyzed. Two groups were formed: those treated with closed reduction and anterograde intramedullary Kirschner wire fixation and those treated with closed reduction and casting. The groups were statistically compared in terms of pre- and post-treatment radiological angulation, functional outcomes, and return to work times. Quick-Disability of Arm, Shoulder and Hand Outcome Measure and visual analog scale (VAS) were used for functional scoring. Results: The study included 33 patients (6 male, 27 female) treated conservatively and 32 patients (4 male, 28 female) treated with closed reduction and anterograde percutaneous pinning. In the closed reduction and casting group, the post-treatment angulation was measured as 19 degrees (10-30). In the anterograde pinning group, the post-treatment angulation was 15 degrees (9-20). At the end of the first year, 5th MC joint flexion was measured as 75 degrees (30-100) in group 1 and 75 degrees (50-100) in group 2. The DASH score was 0 (0-25) in group 1 and 0 (0-40) in group 2. The VAS score was 96 (18-100) in group 1 and 100 (30-100) in group 2. Conclusion: The results of this study suggest that intramedullary Kirschner wire fixation is a safe option for treating 5th MC neck fractures. In addition, an increase in angulation was observed after closed reduction even in cases where acceptable limits of angulation were maintained. While emphasizing the need for more comprehensive research, this study also suggests that surgical treatment could be effective in different angulations.

Keywords

• 5th metacarpal neck fracture
• percutaneous pinning
• conservative treatment
• closed reduction