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

INTRODUCTION

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.

STEP 1 ANTEGRADE INTRAMEDULLARY PINNING OPERATING-ROOM SETUP AND MAKING THE INCISION: Proper positioning of the image intensifier and the treating surgeons is important.

STEP 2 ANTEGRADE INTRAMEDULLARY PINNING BEND THE KIRSCHNER WIRES: Prepare and bend the Kirschner wires before insertion.

STEP 3 ANTEGRADE INTRAMEDULLARY PINNING MAKE A HOLE IN THE FIFTH METACARPAL BASE: Create a hole for Kirschner wire insertion in the center of the fifth metacarpal base.

STEP 4 ANTEGRADE INTRAMEDULLARY PINNING INSERT KIRSCHNER WIRES AND CLOSE THE WOUND: Insert the Kirschner wires through the hole of the fifth metacarpal base.

STEP 5 ANTEGRADE INTRAMEDULLARY PINNING POSTOPERATIVE CARE: An additional skin incision is necessary to remove the Kirschner wires after bone union.

STEP 1 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING OPERATING-ROOM SETUP: Proper positioning of the image intensifier and treating surgeon is important.

STEP 2 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING FRACTURE REDUCTION: Reduce the fifth metacarpal neck fracture using the Jahss maneuver.

STEP 3 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING INSERT KIRSCHNER WIRES: 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.

STEP 4 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING KIRSCHNER WIRE MANAGEMENT: 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.

STEP 5 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING POSTOPERATIVE CARE: The percutaneous Kirschner wire is retrieved.

RESULTS

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.