Heo Youn Moo, Kim Sang Bum, Yi Jin Woong, Kim Tae Gyun, Lim Byoung Gu
1 Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
J Hand Surg Asian Pac Vol. 2016 Feb;21(1):30-6. doi: 10.1142/S242483551650003X.
As intramedullary (IM) fixation is one of the fixation methods used in neck fractures of the fifth metacarpal, an early motion of injured finger can be allowed. The purpose of this study is to evaluate whether immediate active motion affects the stability of antegrade IM fixation in surgical treatment of neck fractures of the fifth metacarpal bone and to assess related factors.
Thirty one patients treated by closed reduction and antegrade IM fixation were consecutively enrolled. All patients started active motion of the little finger since 7 postoperative days and only daily activities including writing, typing or washing were allowed until the union of fracture. All fractures were healed within four to eight weeks. The changes of angulation, fifth metacarpal length and tip to head distance of K-wire were compared between immediate postoperative radiographs and radiographs at eight weeks. In addition, the effects by age, gender, initial angulation and comminution of the metacarpal neck were assessed.
The average change of angulation was 0.12°, 5th metacarpal length was 1.49mm and tip to head distance of K-wire was 1.31mm. There was no significant difference in the change of angulation (p = 0.137). But, there were significant differences in the change of 5th metacarpal length and tip to head distance of K-wire ([Formula: see text]). The change of angulation was related to a comminution of the metacarpal neck and that of 5th metacarpal length was related to age and sex.
The change of 5th metacarpal length and tip to head distance of K-wire can occur by an early mobilization in the antegrade IM fixation for neck fractures of the fifth metacarpal. However, we thought that an early active motion after surgery is important to increase the patients' satisfaction, even though careful selection of candidates is necessary.
由于髓内（IM）固定是用于第五掌骨颈部骨折的固定方法之一，因此受伤手指可早期活动。本研究的目的是评估即时主动活动是否会影响第五掌骨颈部骨折手术治疗中顺行髓内固定的稳定性，并评估相关因素。
连续纳入31例接受闭合复位和顺行髓内固定治疗的患者。所有患者自术后7天起开始进行小指的主动活动，在骨折愈合前仅允许进行包括书写、打字或洗手在内的日常活动。所有骨折均在4至8周内愈合。比较术后即刻X线片与8周时X线片的成角变化、第五掌骨长度以及克氏针尖端至头部的距离。此外，评估年龄、性别、掌骨颈部初始成角和粉碎情况的影响。
平均成角变化为0.12°，第五掌骨长度为1.49mm，克氏针尖端至头部的距离为1.31mm。成角变化无显著差异（p = 0.137）。但是，第五掌骨长度和克氏针尖端至头部距离的变化有显著差异（[公式：见原文]）。成角变化与掌骨颈部粉碎有关，第五掌骨长度变化与年龄和性别有关。
在第五掌骨颈部骨折的顺行髓内固定中，早期活动可导致第五掌骨长度和克氏针尖端至头部距离的变化。然而，我们认为术后早期主动活动对于提高患者满意度很重要，尽管需要仔细挑选合适的患者。
