Haddad Elie, Zemour Marion, Belkacemi Yacine, Al Khoury Salem Hassan, Dohin Bruno
Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France.
Service de Chirurgie Pédiatrique, CHU Hôpital Nord, Avenue Albert Raimond, 42055 Saint Etienne cedex 02, France.
Orthop Traumatol Surg Res. 2022 Feb;108(1):102992. doi: 10.1016/j.otsr.2021.102992. Epub 2021 Jun 27.
Fifth metacarpal neck fracture is the most frequent type of hand fracture in adolescents between 13 and 16 years of age. It mainly affects males and the dominant hand. The L-pinning technique combines intramedullary anterograde pinning and transverse pinning between the 4 and 5 metacarpals. The present study aimed to assess L-pinning without postoperative immobilization in displaced 5 metacarpal fracture in adolescents with low residual growth.
Data for patients aged between 13 and 16 years, operated on for closed 5 metacarpal neck fracture between January 2017 and June 2019, were analyzed retrospectively. Surgery was indicated for angulation with>30° palmar tilt and/or horizontal malalignment. The technique consisted in intramedullary anterograde pinning and transverse pinning between the 4 and 5 metacarpal heads. No postoperative immobilization was applied. Hardware was removed as of day 28. The final clinical check-up was at≥12 months.
Eighteen patients, all male, with a mean age of 14 years, were included. All had bone age≥14 years. Mean palmar tilt was 52°±6.8° versus 6°±2.4° postoperatively, for a mean correction of 45°±4.3°. Mean operating time was 15min, and X-ray exposure 0.36minutes for a mean radiation dose of 2.89 cGy/cm. At hardware removal, all patients showed radiologic consolidation. At 3 months, 5 ray ranges of motion were normal, with no local complications. Functional results were maintained at last follow-up (≥12 months).
L-pinning seemed reliable in terms of feasibility and stability of reduction in 5 metacarpal neck fracture in adolescents. Absence of postoperative immobilization facilitated self-rehabilitation and accelerated functional recovery.
IV.
第五掌骨颈骨折是13至16岁青少年中最常见的手部骨折类型。主要影响男性及优势手。L形穿针技术结合了髓内顺行穿针和第4、5掌骨间的横向穿针。本研究旨在评估在生长剩余较少的青少年移位第五掌骨骨折中采用L形穿针且术后不进行固定的效果。
回顾性分析2017年1月至2019年6月间因闭合性第五掌骨颈骨折接受手术的13至16岁患者的数据。手术指征为掌侧倾斜>30°和/或水平移位。技术包括髓内顺行穿针和第4、5掌骨头间的横向穿针。术后不进行固定。术后28天取出内固定物。最终临床检查在≥12个月时进行。
纳入18例患者，均为男性，平均年龄14岁。所有患者骨龄≥14岁。术前平均掌侧倾斜为52°±6.8°，术后为6°±2.4°，平均矫正45°±4.3°。平均手术时间为15分钟，X线暴露时间为0.36分钟，平均辐射剂量为2.89 cGy/cm。取出内固定物时，所有患者均显示影像学骨愈合。3个月时，5个掌指关节活动范围正常，无局部并发症。末次随访（≥12个月）时功能结果得以维持。
L形穿针在青少年第五掌骨颈骨折复位的可行性和稳定性方面似乎可靠。术后不进行固定有助于自我康复并加速功能恢复。
IV级
