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.	郭宁国, 强晓军, 冯纪川. 闭合复位单根髓内针治疗掌骨颈骨折 61 例分析. 中国误诊学杂志, 2007, 7(13): 3104-3105.
5.	张立山, 潘勇卫, 田光磊. 顺行髓内针内固定术治疗第四、五掌骨骨折的解剖入路研究. 中华手外科杂志, 2010, 26(2): 67-70.
6.	樊晓磊, 王健, 赵建新, 等. 闭合复位顺行克氏针髓内固定结合转棒技术治疗第五掌骨颈骨折. 中华创伤骨科杂志, 2020, 22(2): 170-174.
7.	潘生德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
8.	顾玉东. 如何治疗手部骨折——评 AO 微型钢板的应用价值. 中华手外科杂志, 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, 陈云丰, 等. 顺行双弹性髓内钉与微型钢板内固定治疗第五掌骨骨折的疗效比较. 中华手外科杂志, 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, 王孝辉, 沈素红, 等. 超声引导下闭合复位微创固定治疗肢体骨折的研究进展. 中国医学影像技术, 2017, 33(11): 1740-1743.
18.	周雪添, 郭杨, 司誉豪, 等. 肌肉骨骼超声技术在骨科诊断治疗中的应用现状及机制. 中国组织工程研究, 2019, 23(16): 2573-2578.
19.	Kocaoğlu S, Özhasenekler A, İçme 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, 王孝辉, 李无阴. 超声与 C 臂 X 线机引导闭合复位穿针固定治疗掌指骨骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(10): 1179-1183.
21.	苏海庆, 庄小强, 白宇, 等. 彩色多普勒超声观察骨折骨痂血运的临床价值研究. 中国医学影像技术, 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. 郭宁国, 强晓军, 冯纪川. 闭合复位单根髓内针治疗掌骨颈骨折 61 例分析. 中国误诊学杂志, 2007, 7(13): 3104-3105.
5. 张立山, 潘勇卫, 田光磊. 顺行髓内针内固定术治疗第四、五掌骨骨折的解剖入路研究. 中华手外科杂志, 2010, 26(2): 67-70.
6. 樊晓磊, 王健, 赵建新, 等. 闭合复位顺行克氏针髓内固定结合转棒技术治疗第五掌骨颈骨折. 中华创伤骨科杂志, 2020, 22(2): 170-174.
7. 潘生德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
8. 顾玉东. 如何治疗手部骨折——评 AO 微型钢板的应用价值. 中华手外科杂志, 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, 陈云丰, 等. 顺行双弹性髓内钉与微型钢板内固定治疗第五掌骨骨折的疗效比较. 中华手外科杂志, 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, 王孝辉, 沈素红, 等. 超声引导下闭合复位微创固定治疗肢体骨折的研究进展. 中国医学影像技术, 2017, 33(11): 1740-1743.
18. 周雪添, 郭杨, 司誉豪, 等. 肌肉骨骼超声技术在骨科诊断治疗中的应用现状及机制. 中国组织工程研究, 2019, 23(16): 2573-2578.
19. Kocaoğlu S, Özhasenekler A, İçme 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, 王孝辉, 李无阴. 超声与 C 臂 X 线机引导闭合复位穿针固定治疗掌指骨骨折的疗效比较. 中国修复重建外科杂志, 2017, 31(10): 1179-1183.
21. 苏海庆, 庄小强, 白宇, 等. 彩色多普勒超声观察骨折骨痂血运的临床价值研究. 中国医学影像技术, 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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