Treatment of the fifth metacarpal neck fracture with elastic intramedullary nail under the guidance of high frequency ultrasound_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Laifu ¹ , Lü Yaqing ² , LU Chengyin ¹ ,  WANG Xiaohui ³ , GUO Shaoyong ³ , ZHANG Hailong ³

1. Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China;
2. Department of Ultrasound, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;
3. Department of Hand Microsurgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;

Corresponding?author：

WANG Xiaohui, Email: 963099784@qq.com

Keywords：

High frequency ultrasound; the fifth metacarpal neck fracture; minimally invasive surgery; intramedullary nail

DOI：

10.7507/1002-1892.202008079

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Objective To analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound.Methods The clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association.Results The operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value (t=?20.02, P=0.00); and there was no significant difference (t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference (t=?1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent.Conclusion The effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.

Citation： ZHANG Laifu, Lü Yaqing, LU Chengyin, WANG Xiaohui, GUO Shaoyong, ZHANG Hailong. Treatment of the fifth metacarpal neck fracture with elastic intramedullary nail under the guidance of high frequency ultrasound. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 154-159. doi: 10.7507/1002-1892.202008079 Copy

1.	Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiol, 2009, 50(3): 296-300.
2.	Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plast Reconstr Surg, 2015, 136(3): 370e-379e.
3.	Padegimas EM, Warrender WJ, Jones CM, et al. Metacarpal neck fractures: A review of surgical indications and techniques. Arch Trauma Res, 2016, 5(3): e32933.
4.	郭寧國, 強曉軍, 馮紀川. 閉合復位單根髓內針治療掌骨頸骨折 61 例分析. 中國誤診學雜志, 2007, 7(13): 3104-3105.
5.	張立山, 潘勇衛, 田光磊. 順行髓內針內固定術治療第四、五掌骨骨折的解剖入路研究. 中華手外科雜志, 2010, 26(2): 67-70.
6.	樊曉磊, 王健, 趙建新, 等. 閉合復位順行克氏針髓內固定結合轉棒技術治療第五掌骨頸骨折. 中華創傷骨科雜志, 2020, 22(2): 170-174.
7.	潘生德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
8.	顧玉東. 如何治療手部骨折——評 AO 微型鋼板的應用價值. 中華手外科雜志, 2002, 18(2): 65.
9.	Fujitani R, Omokawa S, Shigematsu K, et al. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci, 2012, 17(4): 450-456.
10.	Facca S, Ramdhian R, Pelissier A, et al. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? Orthop Traumatol Surg Res, 2010, 96(5): 506-512.
11.	Spies CK, Langer M, Hohendorff B, et al. Open reduction and screw/plate osteosynthesis of metacarpal fractures. Oper Orthop Traumatol, 2019, 31(5): 422-432.
12.	Akinleye SD, Garofolo-Gonzalez G, Culbertson MD, et al. Iatrogenic injuries in percutaneous pinning techniques for fifth metacarpal neck fractures. Hand (N Y), 2019, 14(3): 386-392.
13.	Wong VW, Higgins JP. Evidence-based medicine: Management of metacarpal fractures. Plast Reconstr Surg, 2017, 140(1): 140e-151e.
14.	曾浪清, 曾路路, 陳云豐, 等. 順行雙彈性髓內釘與微型鋼板內固定治療第五掌骨骨折的療效比較. 中華手外科雜志, 2019, 35(1): 59-61.
15.	Morgan TA, Piper SL, Lattanza LL, et al. Distal forearm fracture open reduction-internal fixation: Sonographic detection of hardware malalignment and associated tendon injuries missed by radiography. J Ultrasound Med, 2017, 36(10): 2173-2177.
16.	Causeret A, Ract I, Jouan J, et al. A review of main anatomical and sonographic features of subcutaneous nerve injuries related to orthopedic surgery. Skeletal Radiol, 2018, 47(8): 1051-1068.
17.	王雷, 王孝輝, 沈素紅, 等. 超聲引導下閉合復位微創固定治療肢體骨折的研究進展. 中國醫學影像技術, 2017, 33(11): 1740-1743.
18.	周雪添, 郭楊, 司譽豪, 等. 肌肉骨骼超聲技術在骨科診斷治療中的應用現狀及機制. 中國組織工程研究, 2019, 23(16): 2573-2578.
19.	Kocao?lu S, ?zhasenekler A, ??me F, et al. The role of ultrasonography in the diagnosis of metacarpal fractures. Am J Emerg Med, 2016, 34(9): 1868-1871.
20.	王雷, 王孝輝, 李無陰. 超聲與 C 臂 X 線機引導閉合復位穿針固定治療掌指骨骨折的療效比較. 中國修復重建外科雜志, 2017, 31(10): 1179-1183.
21.	蘇海慶, 莊小強, 白宇, 等. 彩色多普勒超聲觀察骨折骨痂血運的臨床價值研究. 中國醫學影像技術, 2004, 20(6): 906-908.

1. Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiol, 2009, 50(3): 296-300.
2. Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plast Reconstr Surg, 2015, 136(3): 370e-379e.
3. Padegimas EM, Warrender WJ, Jones CM, et al. Metacarpal neck fractures: A review of surgical indications and techniques. Arch Trauma Res, 2016, 5(3): e32933.
4. 郭寧國, 強曉軍, 馮紀川. 閉合復位單根髓內針治療掌骨頸骨折 61 例分析. 中國誤診學雜志, 2007, 7(13): 3104-3105.
5. 張立山, 潘勇衛, 田光磊. 順行髓內針內固定術治療第四、五掌骨骨折的解剖入路研究. 中華手外科雜志, 2010, 26(2): 67-70.
6. 樊曉磊, 王健, 趙建新, 等. 閉合復位順行克氏針髓內固定結合轉棒技術治療第五掌骨頸骨折. 中華創傷骨科雜志, 2020, 22(2): 170-174.
7. 潘生德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
8. 顧玉東. 如何治療手部骨折——評 AO 微型鋼板的應用價值. 中華手外科雜志, 2002, 18(2): 65.
9. Fujitani R, Omokawa S, Shigematsu K, et al. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci, 2012, 17(4): 450-456.
10. Facca S, Ramdhian R, Pelissier A, et al. Fifth metacarpal neck fracture fixation: Locking plate versus K-wire? Orthop Traumatol Surg Res, 2010, 96(5): 506-512.
11. Spies CK, Langer M, Hohendorff B, et al. Open reduction and screw/plate osteosynthesis of metacarpal fractures. Oper Orthop Traumatol, 2019, 31(5): 422-432.
12. Akinleye SD, Garofolo-Gonzalez G, Culbertson MD, et al. Iatrogenic injuries in percutaneous pinning techniques for fifth metacarpal neck fractures. Hand (N Y), 2019, 14(3): 386-392.
13. Wong VW, Higgins JP. Evidence-based medicine: Management of metacarpal fractures. Plast Reconstr Surg, 2017, 140(1): 140e-151e.
14. 曾浪清, 曾路路, 陳云豐, 等. 順行雙彈性髓內釘與微型鋼板內固定治療第五掌骨骨折的療效比較. 中華手外科雜志, 2019, 35(1): 59-61.
15. Morgan TA, Piper SL, Lattanza LL, et al. Distal forearm fracture open reduction-internal fixation: Sonographic detection of hardware malalignment and associated tendon injuries missed by radiography. J Ultrasound Med, 2017, 36(10): 2173-2177.
16. Causeret A, Ract I, Jouan J, et al. A review of main anatomical and sonographic features of subcutaneous nerve injuries related to orthopedic surgery. Skeletal Radiol, 2018, 47(8): 1051-1068.
17. 王雷, 王孝輝, 沈素紅, 等. 超聲引導下閉合復位微創固定治療肢體骨折的研究進展. 中國醫學影像技術, 2017, 33(11): 1740-1743.
18. 周雪添, 郭楊, 司譽豪, 等. 肌肉骨骼超聲技術在骨科診斷治療中的應用現狀及機制. 中國組織工程研究, 2019, 23(16): 2573-2578.
19. Kocao?lu S, ?zhasenekler A, ??me F, et al. The role of ultrasonography in the diagnosis of metacarpal fractures. Am J Emerg Med, 2016, 34(9): 1868-1871.
20. 王雷, 王孝輝, 李無陰. 超聲與 C 臂 X 線機引導閉合復位穿針固定治療掌指骨骨折的療效比較. 中國修復重建外科雜志, 2017, 31(10): 1179-1183.
21. 蘇海慶, 莊小強, 白宇, 等. 彩色多普勒超聲觀察骨折骨痂血運的臨床價值研究. 中國醫學影像技術, 2004, 20(6): 906-908.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of the fifth metacarpal neck fracture with elastic intramedullary nail under the guidance of high frequency ultrasound

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