title: Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients.
abstract: Although extra-articular metacarpal fractures are common, there is no consensus on the mode of treatment. We evaluated the outcome in 67 patients operated for isolated, extra-articular fractures in the neck or shaft of the ulnar two metacarpals 28 months post-operatively. There were 22 bouquet (intra-medullary) pinnings and 45 transverse pinnings; 11 were lost to follow-up. Overall, hand function was good, and no difference was detected between the two methods (QuickDASH, grip strength, range of motion, VAS pain and VAS satisfaction). Many patients suffered complications: 12% had a superficial infection (all treated with transverse pinning with wires left exposed); 39% had some impairment in skin sensation; 29% reported cold intolerance; and 10% had other complications. Due to the potential risk of a secondary fracture of the neighbouring metacarpal after transverse pinning, we recommend bouquet (intra-medullary) pinning. We also recommend burying wires beneath the skin surface to avoid infection.
authors.affiliation: Department of Orthopaedics, Oslo University Hospital, Oslo, Norway. ida.sletten@live.no
authors.forename: I N
authors.initials: IN
authors.lastname: Sletten
authors.forename: L
authors.initials: L
authors.lastname: Nordsletten
authors.forename: T
authors.initials: T
authors.lastname: Husby
authors.forename: R A
authors.initials: RA
authors.lastname: Ødegaard
authors.forename: J C
authors.initials: JC
authors.lastname: Hellund
authors.forename: H D
authors.initials: HD
authors.lastname: Kvernmo
mesh_terms: D000328:Adult; D001858:Bone Nails; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries* / Q000601:surgery; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D055815:Young Adult