CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2021; 49(02): e115-e120
DOI: 10.1055/s-0041-1739170
Original Article | Artículo Original

Fifth Metacarpal Neck Fractures: Outcome-influencing Factors

Article in several languages: English | español
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
,
Ana Ribau
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
,
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
,
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
,
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
,
1   Department of Orthopedics, Centro Hospitalar do Porto, Porto, Portugal
› Author Affiliations

Abstract

Introduction Fifth metacarpal neck fractures are extremely common, but there is still no consensus regarding the ideal course of treatment.

Volar angulation and shortening are decisive factors; however, there is still controversy about the cut-off values that translate into worse clinical results.

The present study aims to answer these questions in order to provide additional data to aid in the clinical practice and decision making.

Materials and Methods A retrospective study evaluated patients with fifth metacarpal fractures treated between 2013 and 2018. A total of 133 patients were included, with an average follow-up of 2 months. Surgery was performed in 21 patients, and 112 were treated conservatively. The radiological assessment of volar anguation and shortening was based in the first and last radiographs of the follow-up. The patients were contacted and submited to a questionnaire that included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and subjective evaluations of pain (Visual Analogue Scale, VAS), hand strength, stiffness and finger mobility, and cosmetic result.

Results Surgery was more successful in reducing angulation than the conservative treatment, achieving more anatomic final values for angulation and shortening (p < 0.05). On the other hand, surgery seems to be associated with a higher notion of limited finger mobility (p = 0.02).

Among patients treated conservatively, inicial angulations > 60° and final angulations > 50° were associated with worse cosmetic results (p = 0,039). Final shortening > 4 mm translated into a higher notion of stiffness and limited finger mobility (p = 0.034).

More advanced age showed a correlation with higher scores on the VAS (p = 0.023) and QuickDASH (p < 0,001). Female patients (p = 0.02) were also associated with higher VAS scores. The overall satisfaction rate was of 97%.

Conclusion Although globally the functional outcome of these fractures is very good, the present study reports several factors that should be considered when treating fifth metacarpal neck fractures.



Publication History

Received: 26 February 2021

Accepted: 09 August 2021

Article published online:
13 December 2021

© 2021. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • References

  • 1 Pace GI, Gendelberg D, Taylor KF. The Effect of Closed Reduction of Small Finger Metacarpal Neck Fractures on the Ultimate Angular Deformity. J Hand Surg Am 2015; 40 (08) 1582-1585
  • 2 Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005; (03) CD003210 DOI: 10.1002/14651858.CD003210.pub3.
  • 3 Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg 2003; 123 (10) 534-537 DOI: 10.1177/1753193412461582.
  • 4 Theeuwen GA, Lemmens JA, van Niekerk JL. Conservative treatment of boxer's fracture: a retrospective analysis. Injury 1991; 22 (05) 394-396
  • 5 Braakman M. Is anatomical reduction of fractures of the fourth and fifth metacarpals useful?. Acta Orthop Belg 1997; 63 (02) 106-109
  • 6 Hansen PB, Hansen TB. The treatment of fractures of the ring and little metacarpal necks. A prospective randomized study of three different types of treatment. J Hand Surg [Br] 1998; 23 (02) 245-247
  • 7 Harding IJ, Parry D, Barrington RL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg [Br] 2001; 26 (03) 261-263
  • 8 Lord RE. Intramedullary fixation of metacarpal fractures. J Am Med Assoc 1957; 164 (16) 1746-1749
  • 9 Orbay JL, Touhami A. The treatment of unstable metacarpal and phalangeal shaft fractures with flexible nonlocking and locking intramedullary nails. Hand Clin 2006; 22 (03) 279-286
  • 10 Schädel-Höpfner M, Wild M, Windolf J, Linhart W. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?. Arch Orthop Trauma Surg 2007; 127 (06) 435-440
  • 11 Lamb DW, Abernethy PA, Raine PA. Unstable fractures of the metacarpals. A method of treatment by transverse wire fixation to intact metacarpals. Hand 1973; 5 (01) 43-48
  • 12 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
  • 13 Sletten IN, Nordsletten L, Hjorthaug GA, Hellund JC, Holme I, Kvernmo HD. Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur Vol 2013; 38 (06) 658-666 DOI: 10.1177/1753193412461582.
  • 14 Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y) 2014; 9 (01) 16-23
  • 15 Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer's fractures. J Hand Surg Am 1999; 24 (04) 835-844
  • 16 Lamraski G, Monsaert A, De Maeseneer M, Haentjens P. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res 2006; 24 (01) 37-45
  • 17 Lowdon IM. Fractures of the metacarpal neck of the little finger. Injury 1986; 17 (03) 189-192