title: Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?
abstract: BACKGROUND
  It is generally accepted that severely displaced or malrotated neck fractures of the fifth metacarpal should be treated by closed reduction and pinning. As antegrade intramedullary splinting avoids adhesions of the extensor hood and provides intramedullary stability this technique seems to be advantageous in comparison with traditional retrograde percutaneous crossed pinning. We raised the question whether the antegrade technique would give clinical and radiological results superior to the retrograde technique and investigated this within a comparative clinical study.
  
  
  METHODS
  Thirty patients with displaced neck fractures of the fifth metacarpal who received operative treatment were included in a retrospective cohort study. Data was analysed from medical records and a clinical and radiological outcome evaluation was performed. Fifteen patients had antegrade intramedullary splinting and fifteen patients retrograde percutaneous pinning. Median time for follow-up was 17 and 18 months, respectively.
  
  
  RESULTS
  A significantly better outcome was found after antegrade splinting for ROM restriction of the metacarpophalangeal joint (0 degrees vs. -15 degrees ; P = 0.016), shortening (P = 0.029), pain (0 vs. 5; VAS 0-100; P = 0.026), and overall assessment by the Steel score (400 vs. 357; P = 0.001). There was no statistical difference in grip strength and functional assessment by the DASH score.
  
  
  CONCLUSIONS
  From our clinical and radiological data we conclude that antegrade intramedullary splinting is superior to retrograde percutaneous crossed pinning and thus should be preferentially considered for displaced neck fractures of the fifth metacarpal.
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225 Düsseldorf, Germany. schaedel@uni-duesseldorf.de
authors.forename: M
authors.initials: M
authors.lastname: Schädel-Höpfner
authors.forename: M
authors.initials: M
authors.lastname: Wild
authors.forename: J
authors.initials: J
authors.lastname: Windolf
authors.forename: W
authors.initials: W
authors.lastname: Linhart
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries*; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome