Surgical Outcomes of Percutaneous Pinning and Open Locking Plating in Patients With Intra-articular Fractures of the Base of the Fifth Metacarpal

Jung Il Lee; Jong Woong Park; Yong Jin You; Young Hoon Jo; Ki-Chul Park

doi:10.1016/j.jhsa.2023.03.024

Surgical Outcomes of Percutaneous Pinning and Open Locking Plating in Patients With Intra-articular Fractures of the Base of the Fifth Metacarpal

J Hand Surg Am. 2023 May 6:S0363-5023(23)00175-2. doi: 10.1016/j.jhsa.2023.03.024. Online ahead of print.

Authors

Jung Il Lee¹, Jong Woong Park², Yong Jin You³, Young Hoon Jo³, Ki-Chul Park³

Affiliations

¹ Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea. Electronic address: osjungil@gmail.com.
² Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea.
³ Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea.

PMID: 37149801
DOI: 10.1016/j.jhsa.2023.03.024

Abstract

Purpose: The purpose of the study was to demonstrate the results of surgical treatment, including percutaneous K-wire fixation after closed reduction (CRKF) or locking plate fixation after open reduction (ORPF), in patients with intra-articular fractures of the base of the fifth metacarpal.

Methods: We retrospectively reviewed data of 29 patients who received surgical treatment for closed, intra-articular fractures of the base of the fifth metacarpal and were followed up for at least 1 year after surgery. Sixteen of the 29 patients underwent CRKF, whereas 13 patients underwent ORPF. Attempts were made to address intra-articular step-off with closed reduction in all the patients; however, if inadequate, ORPF was performed. Clinical outcomes were evaluated using Disabilities of the Arm, Shoulder, and Hand scores, visual analog scale pain scores, the total active motion (TAM) of the little finger, and grip strength. Osseous union and posttraumatic arthritis of the fifth carpometacarpal joint were also evaluated.

Results: K-wire fixation after closed reduction was performed for 13 simple fractures and 3 comminuted fractures; ORPF was performed for 6 simple fractures and 7 comminuted fractures. All the patients had satisfactory subjective outcomes with over 90% grip strength compared with that on the contralateral side and nearly full TAM. All the patients in both the groups achieved osseous union. There were five cases of grade 1 posttraumatic arthritis after CRKF and seven cases of grade 1 posttraumatic arthritis after ORPF.

Conclusions: Surgical treatment provided satisfactory results in patients with intra-articular fractures of the base of the fifth metacarpal treated with either CRKF or ORPF. Our data showed that the patients who underwent CPKF had good results, and those who underwent ORPF after attempt failure of close reduction also had good results. Our experience suggests that ORPF can be a backup plan when CRKF cannot be accomplished in a satisfactory way.

Type of study/level of evidence: Therapeutic IV.

Keywords: Bennett; fifth metacarpal; fracture; hand; metacarpal; reverse Bennett.