Khan J, Shrestha S K, Pradhan N M, Acharya B K M, Khanal P
Department of Orthopedics and Trauma Surgery, Universal College of Medical Science, Bhairahawa, Nepal.
J Nepal Health Res Counc. 2012 Jan;10(1):61-5.
Isolated fractures of metacarpals and phalanges are the commonest injuries affected upper extremity, which constitute about 10% of skeletal fractures in general. Fifth metacarpal (boxer's fractures) being the most common. The objective of this study was to investigate the outcome of treatment of the displaced neck and sub-capital fractures of the fifth metacarpal by percutaneous K wire fixation.
An observational study was conducted in the department of orthopedics Patan hospital as an outpatient procedure from January 2010 to January 2012. All adult patients with unilateral fracture of neck of fifth metacarpal bone were included. Whose physis was open, having previous hand injury or diseases causing deformity or impaired hand function and when fracture was more than 7 days old, were excluded from the study.
Twenty eight of 35 patients obtained anatomic reduction, and 7 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for only 30 patients. The follow-up time was up to 12 weeks. The head/shaft angle of the fifth metacarpal was 60.60 degrees ±9.39 degrees preoperatively, and 14.20 degrees ±7.32 degrees postoperatively, and 15.60 degrees ±6.95 degrees in 12 weeks postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 86.73 degrees ±6.13 degrees postoperatively, which was not significantly different compared with that of uninjured side which was 90.93 degrees ±3.18. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was not significantly different compared with that of uninjured side. The average union time was 5.46 weeks ±1.22.
This method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced in retrograde fashion makes it easier to correctly place the wire, which gives reasonably stable fixation, gives excellent results in a high proportion of selected cases. Local anesthesia is an added advantage.
掌骨和指骨的孤立性骨折是上肢最常见的损伤，约占全身骨骼骨折的10%。其中第五掌骨骨折（拳击手骨折）最为常见。本研究的目的是探讨经皮克氏针固定治疗第五掌骨颈移位骨折和掌骨基底骨折的疗效。
2010年1月至2012年1月在帕坦医院骨科作为门诊手术进行一项观察性研究。纳入所有成年单侧第五掌骨颈骨折患者。排除骨骺开放、既往有手部损伤或疾病导致畸形或手部功能受损以及骨折超过7天的患者。
35例患者中有28例获得解剖复位，7例骨端对位2/3且无旋转畸形。仅30例患者获得随访。随访时间长达12周。第五掌骨的头/干角术前为60.60度±9.39度，术后为14.20度±7.32度，术后12周为15.60度±6.95度。术前和术后角度差异具有高度显著性。掌指关节术后活动范围为86.73度±6.13度，与未受伤侧的90.93度±3.18度相比无显著差异。术前和术后角度差异具有高度显著性。掌指关节活动范围与未受伤侧相比无显著差异。平均愈合时间为5.46周±1.22周。
本方法不干扰骨折部位本身，逆行插入克氏针使其更容易正确置入，能提供合理稳定的固定，在大部分选定病例中效果良好。局部麻醉是一个额外的优点。
