![]() If necessary, part of the joint capsule could be appropriately opened to make sure that the plate and screw could be placed. Three to four screws were placed in the proximal part of the fracture and one screw was placed in the distal part (Fig. After the reduction was confirmed to be satisfactory by C-arm fluoroscopy, a straight F3 locking plate (Zimmer Biomet, Warsaw, Indiana, USA) was inserted. ![]() Due to local anesthesia, the patients could actively move the joint during the operations, and the unaffected extension and flexion functions were the main references for the length of the Kirschner wire tail. Generally, 3–5 mm was left on the outside of the metacarpal head, so as to facilitate the removal of internal fixation and minimize the impacts on the metacarpophalangeal joint capsule and extensor retinaculum. After the Kirschner wire was inserted, the excess part of the tail needed to be cut off. The first Kirschner wire was inserted from the ulnar side to the radial side and the second was opposite. Both Kirschner wires were inserted from the distal part to the proximal part of the fracture and penetrated two layers of cortical bone. 1a), while another surgeon inserted cross Kirschner wires to fix the fracture (Fig. ![]() One surgeon pulled the little finger to the distal side to reduce the fracture and flexed the metacarpophalangeal joint (Fig. The scars and hyperplasia around the fracture were removed thoroughly. A dorsal incision was made, and the fracture was exposed through the space between the extensor tendons. A dose of 3 ml lidocaine was injected every 1.5–2 cm from the base of the metacarpal bone to the distal end and the injection needle was inserted vertically to the surface of the metacarpal bone. The aim of this study was to retrospectively analyze the results of the modified internal fixation method for the treatment of fifth metacarpal neck fracture.Įach operation was performed with local anesthesia and an electric tourniquet. To solve this problem, we adopted a new method of fixation with Kirschner wires and locking plates. However, one screw is not stable enough to guarantee the fixation strength. However, the fracture line of the fifth metacarpal neck is always very close to the metacarpal head, and there is often not enough space to place two screws in the distal part of the fracture. The use of the medial locking plate was reported in the treatment of the fifth metacarpal neck fracture, and two screws were inserted into the distal part of the fracture, which could achieve satisfactory effects. For the old fifth metacarpal neck fractures with the failure of closed reduction, open reduction and plate internal fixation are often required. Kirschner wire fixation and plate fixation are two common surgical treatment methods. Some scholars hold the view that angulation (more than 30) can lead to a decrease of flexion force in extrinsic tendons and loss of grip strength, and this kind of fracture should be treated surgically. The controversy over the treatment of the fifth metacarpal neck fracture has never ceased. The fracture of the fifth metacarpal neck is very common in the clinical work of orthopedics and hand surgery. The modified internal fixation method is one of the alternative treatments for the fifth metacarpal neck fracture with good curative effects. QDASH score was 2.0 ± 1.0, and the time of return to work was 6.0 ± 0.7 weeks. At the last follow-up, the range of motion of the fifth metacarpophalangeal joint of the injured side and the contralateral side were 84.3 ± 3.6°and 86.5 ± 2.0°, and the grip strength of the injured side and the contralateral side were 74.8 ± 6.1 LB and 78.6 ± 8.3 LB, respectively, without statistically significant differences. The length of the fifth metacarpals of preoperative and postoperative deformity were 51.5 ± 2.1 mm and 60.0 ± 1.8 mm, respectively. The mean follow-up time was 16.8 months, and the angulations of preoperative and postoperative deformity were 40.0 ± 3.7°and 17.6 ± 1.7°, respectively. Each patient’s gender, age, dominant hand, injured hand, trauma mechanism, preoperative and postoperative deformity (angulation and the length of the fifth metacarpal), the range of motion of the metacarpophalangeal joint and grip strength of each side, the time of return to work, and follow-up time were recorded and calculated. ![]() Methodsįrom March 2018 to December 2019, 12 patients with the fifth metacarpal neck fractures of the hands were treated with the Kirschner wires and locking plate internal fixation method. To evaluate the efficacy of a modified internal fixation method for the treatment of fifth metacarpal neck fracture.
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