Department of Orthopaedics, Xiangya Hospital, Central South University, 410008, Changsha, China.
Department of Orthopaedics, Karamay Central Hospital of Xinjiang, NO.67 Zhungeer Road, Karamay District, 834000, Karamay, China.
BMC Musculoskelet Disord. 2021 Jun 15;22(1):546. doi: 10.1186/s12891-021-04436-w.
Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes.
In this retrospective study, 21 children (aged 11-16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.
All patients were followed up for 12-24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2-4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0-4), the mean VAS was 0.19 ± 0.60 (range, 0-2), and the mean grip strength was 91.55 %±4.52 % (range, 85-101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified.
Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity.
Level IV.
顺行髓内钉（AIMN）联合克氏针（K-wire）是一种微创接骨术。该技术已广泛应用于治疗成人第五掌骨颈骨折（FMNF）。本研究旨在确定在青少年中使用单根 K-wire 进行 AIMN 是否具有良好的临床和影像学结果。
本回顾性研究纳入 2017 年 5 月至 2020 年 1 月我院采用 AIMN 联合单根 K-wire 治疗的 21 例 FMNF 患儿。干预指征为严重移位伴旋转移位畸形、背侧成角大于 40°或两者兼有。收集的数据包括背侧成角、第五掌指关节（MCP）活动度、疼痛视觉模拟评分（VAS）、握力和上肢功能障碍（DASH）评分。
所有患者均获得随访，随访时间 12-24 个月（平均 16.57 个月），所有患者术后均获得解剖复位。愈合时间为 2.69±0.83 个月（范围 2-4 个月）。术后平均背侧成角由 44.49°±2.64°显著降低至 15.74°±2.47°（P<0.001）。患侧 MCP 关节活动度和背侧成角与健侧无显著差异。平均 DASH 评分为 1.76±1.48（范围 0-4），平均 VAS 评分为 0.19±0.60（范围 0-2），平均握力为 91.55%±4.52%（范围 85-101%）。随访期间未见继发性移位、功能障碍、骨不连、感染或骨坏死。尽管 1 例患者发现骺早闭，但无长期角度或缩短的临床发现。
对于青少年 FMNF，单根 K-wire 顺行髓内固定是一种有效且可靠的技术，可获得良好的功能和美容效果。对于接近骨骼成熟的患儿，对骺板的影响较小。
IV 级。
