Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy.
Injury. 2012 Feb;43(2):242-5. doi: 10.1016/j.injury.2011.10.036. Epub 2011 Dec 10.
The purpose of this study was to report the medium-term results in 28 patients affected by closed displaced fractures of the neck of the fifth metacarpal bone (boxer's fracture) with an associated severe swelling of the hand, who were treated with percutaneous transverse K-wire pinning, to verify the effectiveness of this surgical treatment. We opted for this treatment in all cases in which malrotation of the fifth finger and volar angulation of the metacarpal head greater than 30° were associated with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 25 months after surgery. At the final follow-up, no patient reported residual pain. All patients had full extension of the fifth finger, except two in whom we observed a limitation of the extension of the fifth metacarpophalangeal (MP) joint of about 10°, without significant impairment of hand function. All patients had at least 90° flexion of the fifth MP joint and full range of motion of the interphalangeal (IP) joints. No patient had rotational deformity of the fifth finger with a deficit of grip strength. At the final follow-up, a residual palmar angulation of the head of the fifth metacarpal was found in three patients, with a mean of 7°. The disabilities of the arm, shoulder and hand (DASH) scale had a mean value of 5, and all patients considered their result as good or excellent. We recommend percutaneous transverse pinning in all boxer's fractures in which operative treatment is indicated, especially in patients with severe soft-tissue swelling. The surgical procedure is easy to perform, and surgical results are generally good.
本研究旨在报告 28 例闭合性、移位性第五掌骨颈骨折（拳击手骨折）伴手部严重肿胀患者的中期结果，这些患者均采用经皮横向 K 型钉固定治疗，以验证这种手术治疗的有效性。我们选择对所有存在以下情况的患者进行这种治疗：第五指旋转移位和掌骨头向掌侧成角大于 30°，且手部严重肿胀。所有患者均平均在术后 25 个月接受临床和影像学复查。在最终随访时，没有患者报告残留疼痛。所有患者的第五指均完全伸展，只有 2 例观察到第五掌指关节（MP）伸展受限约 10°，但对手部功能无明显影响。所有患者第五 MP 关节的屈曲度至少为 90°，指间关节活动度完全正常。没有患者出现第五指旋转畸形和握力不足。在最终随访时，3 例患者第五掌骨头仍存在残留掌侧成角，平均为 7°。上肢功能障碍（DASH）量表的平均评分为 5，所有患者均认为其结果为良好或优秀。我们建议对所有需要手术治疗的拳击手骨折患者采用经皮横向钉固定治疗，尤其是对存在严重软组织肿胀的患者。手术操作简单，手术结果通常较好。
