Department of Orthopaedic Surgery, Inha University Hospital, Incheon 22332, Republic of Korea.
Medicina (Kaunas). 2023 Nov 3;59(11):1944. doi: 10.3390/medicina59111944.
: Since the neck is the weakest part of the metacarpals, the most common metacarpal fracture is a neck fracture, a type which accounts for 38% of all hand fractures. Such fractures can be fixed using a variety of conventional techniques, including intramedullary pinning and K-wire pinning. However, conventional techniques involve complications, such as angulation, stiffness, and rotational deformity. The purpose of this study was to compare the usefulness of our new technique, combined intramedullary pinning with K-wire pinning (IPKP), with those of intramedullary pinning (IP) and K-wire pinning (KP). : This was a single-center, randomized controlled trial conducted between January 2005 and April 2023. A total of 158 patients with acute displaced fractures of the fifth-metacarpal neck were randomly assigned to either the IPKP group ( = 48), the KP group ( = 60), or the IP group ( = 50). We radiographically evaluated angulation and shortening in three visits: pre-operatively, post-operatively, and at a 1-year follow-up. We clinically evaluated the ranges of motion and Quick-DASH scores to assess daily living performance and the cosmetic scores, using the SBSES score, to assess patients' satisfaction with their cosmetic outcomes. The IPKP group was superior to the KP group and the IP group regarding radiographical and clinical assessments at the 1-year follow-up visit. The angulation was 15.7° (±7.7) in the KP group, 17.0° (±5.9) in the IP group, and 12.6° (±2.5) in the IPKP group ( < 0.001) at the 1-year follow-up visit. The shortening was 0.9 mm (±0.3) in the KP group, 1.4 mm (±0.2) in the IP group, and 0.4 mm (±0.1) in the IPKP group (m < 0.001) at the 1-year follow-up visit. The TAM was 272.6° (±17.5) in the KP group, 271.1° (±18.0) in the IP group, and 274.1° (±14.9) in the IPKP group ( = 0.42). Four patients (6.6%) in the KP group and two patients (4%) in the IP group were reported as having stiffness, while no patients were found to have stiffness in the IPKP group. The average Quick-DASH score was 2.3 (±0.5) in the KP group, 2.5 (±0.4) in the IP group, and 1.9 (±0.4) in the IPKP group ( > 0.05). The average cosmetic score was 3.7 (±1.2) in the KP group, 3.8 (±0.9) in the IP group, and 4.7 (±0.8) in the IPKP group ( < 0.001). A complication involving nonunion occurred in one case (1.6%) in the KP group, while there were three cases (6%) of rotational deformity in the IP groups. : With the IPKP technique, accurate reduction can be achieved to improve hand function and cosmetic outcomes.
：由于颈部是掌骨最脆弱的部位，最常见的掌骨骨折是颈骨折，占手部骨折的 38%。这种骨折可以通过多种传统技术固定，包括髓内针固定和 K 线固定。然而，传统技术涉及到并发症，如成角、僵硬和旋转畸形。本研究的目的是比较我们的新技术——髓内针联合 K 线固定（IPKP）与髓内针固定（IP）和 K 线固定（KP）的效果。：这是一项于 2005 年 1 月至 2023 年 4 月期间进行的单中心、随机对照试验。共有 158 例急性第五掌骨颈移位骨折患者被随机分配至 IPKP 组（n=48）、KP 组（n=60）或 IP 组（n=50）。我们在术前、术后和 1 年随访时进行了 3 次影像学评估，以评估成角和缩短。我们通过 Quick-DASH 评分评估了日常活动的关节活动度和日常生活表现，使用 SBSES 评分评估了患者对美容结果的满意度。在 1 年随访时，IPKP 组在影像学和临床评估方面均优于 KP 组和 IP 组。KP 组的成角为 15.7°（±7.7），IP 组为 17.0°（±5.9），IPKP 组为 12.6°（±2.5）（<0.001）。KP 组的缩短为 0.9 毫米（±0.3），IP 组为 1.4 毫米（±0.2），IPKP 组为 0.4 毫米（±0.1）（m<0.001）。KP 组的 TAM 为 272.6°（±17.5），IP 组为 271.1°（±18.0），IPKP 组为 274.1°（±14.9）（=0.42）。KP 组有 4 例（6.6%）和 IP 组有 2 例（4%）患者报告有僵硬，而 IPKP 组没有患者出现僵硬。KP 组的平均 Quick-DASH 评分为 2.3（±0.5），IP 组为 2.5（±0.4），IPKP 组为 1.9（±0.4）（>0.05）。KP 组的平均美容评分是 3.7（±1.2），IP 组是 3.8（±0.9），IPKP 组是 4.7（±0.8）（<0.001）。KP 组有 1 例（1.6%）发生非愈合并发症，IP 组有 3 例（6%）发生旋转畸形。：使用 IPKP 技术，可以实现准确的复位，从而改善手部功能和美容效果。
