Yi Ju Won, Yoo Sung Lim, Kim Jae Kwang
Department of Orthopedic Surgery, Armed Forces Capital Hospital, Gyeonggi, South Korea.
Department of Orthopedic Surgery, Ewha Womans University School of Medicine, Ewha Womans University Medical Center, Seoul, South Korea.
JBJS Essent Surg Tech. 2016 May 25;6(2):e21. doi: 10.2106/JBJS.ST.16.00006. eCollection 2016 Jun 22.
Although the majority of fifth metacarpal neck fractures can be treated nonoperatively, surgery may be indicated when there is severe shortening or angulation of the metacarpal bone.
STEP 1 ANTEGRADE INTRAMEDULLARY PINNING OPERATING-ROOM SETUP AND MAKING THE INCISION: Proper positioning of the image intensifier and the treating surgeons is important.
STEP 2 ANTEGRADE INTRAMEDULLARY PINNING BEND THE KIRSCHNER WIRES: Prepare and bend the Kirschner wires before insertion.
STEP 3 ANTEGRADE INTRAMEDULLARY PINNING MAKE A HOLE IN THE FIFTH METACARPAL BASE: Create a hole for Kirschner wire insertion in the center of the fifth metacarpal base.
STEP 4 ANTEGRADE INTRAMEDULLARY PINNING INSERT KIRSCHNER WIRES AND CLOSE THE WOUND: Insert the Kirschner wires through the hole of the fifth metacarpal base.
STEP 5 ANTEGRADE INTRAMEDULLARY PINNING POSTOPERATIVE CARE: An additional skin incision is necessary to remove the Kirschner wires after bone union.
STEP 1 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING OPERATING-ROOM SETUP: Proper positioning of the image intensifier and treating surgeon is important.
STEP 2 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING FRACTURE REDUCTION: Reduce the fifth metacarpal neck fracture using the Jahss maneuver.
STEP 3 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING INSERT KIRSCHNER WIRES: Fix the reduced metacarpal neck fracture using 2 Kirschner wires placed percutaneously in a retrograde direction, with the second wire inserted after the first wire passes the fracture site but before it passes the metacarpal base.
STEP 4 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING KIRSCHNER WIRE MANAGEMENT: The proximal end of the Kirschner wire penetrating outside the dorsal skin of the wrist enables the surgeon to percutaneously retrieve the Kirschner wire after fracture union.
STEP 5 PERCUTANEOUS RETROGRADE INTRAMEDULLARY PINNING POSTOPERATIVE CARE: The percutaneous Kirschner wire is retrieved.
In a previous prospective randomized analysis of patients treated with antegrade intramedullary pinning and percutaneous retrograde intramedullary pinning for displaced fifth metacarpal neck fracture, we found that the flexion arc of the MCP joint, visual analog pain scale score, grip strength, and DASH (Disabilities of the Arm, Shoulder and Hand) score were significantly better in the antegrade intramedullary pinning group at 3 months postoperatively.
尽管大多数第五掌骨颈骨折可采用非手术治疗，但当掌骨出现严重短缩或成角时，可能需要手术治疗。
步骤1 顺行髓内穿针 手术室设置及切口：影像增强器和主刀医生的正确定位很重要。
步骤2 顺行髓内穿针 弯曲克氏针：在插入克氏针前进行准备并弯曲。
步骤3 顺行髓内穿针 在第五掌骨基底部钻孔：在第五掌骨基底部中央为克氏针插入创建一个孔。
步骤4 顺行髓内穿针 插入克氏针并关闭伤口：通过第五掌骨基底部的孔插入克氏针。
步骤5 顺行髓内穿针 术后护理：骨愈合后需要额外的皮肤切口来取出克氏针。
步骤1 经皮逆行髓内穿针 手术室设置：影像增强器和主刀医生的正确定位很重要。
步骤2 经皮逆行髓内穿针 骨折复位：使用雅斯手法复位第五掌骨颈骨折。
步骤3 经皮逆行髓内穿针 插入克氏针：使用2根克氏针经皮逆行固定复位后的掌骨颈骨折，第二根针在第一根针通过骨折部位但未通过掌骨基底部之前插入。
步骤4 经皮逆行髓内穿针 克氏针处理：克氏针近端穿出腕背侧皮肤，使医生能够在骨折愈合后经皮取出克氏针。
步骤5 经皮逆行髓内穿针 术后护理：取出经皮克氏针。
在先前一项对移位性第五掌骨颈骨折采用顺行髓内穿针和经皮逆行髓内穿针治疗的患者进行的前瞻性随机分析中，我们发现术后3个月时，顺行髓内穿针组的掌指关节屈曲弧、视觉模拟疼痛量表评分、握力和上肢、肩部和手部功能障碍（DASH）评分明显更好。
