Table 2.
Selected studies
| Authors | Comparative treatment (# of patients) | Antegrade or retrograde IM fixation (# of patients) | Inclusions/exclusions | Outcome measures | Level of evidence, study design | Author conclusions |
|---|---|---|---|---|---|---|
| Facca et al. [11] | Locked plate (18) | Antegrade (20) | Inclusions: Closed, isolated, displaced 5th metacarpal neck fractures | ROM, radiographic measures, grip strength, VAS for pain, DASH, and complication rates | II, Prospective Comparative Study | IM fixation remains the reference technique for displaced fifth metacarpal neck fractures. |
| Exclusions: Recurrent, open, and/or multiple fractures (metacarpal or other) | ||||||
| Fujitani et al. [16] | Low-profile plates (15) | Antegrade (15) | Inclusions: Unstable fractures with a dorsal angulation of more than 30° or with a shortening more than 3 mm | ROM, radiographic measures, complication rates and grip strength | II, Prospective Comparative Study | Low profile PS fixation should be used for patients refusing bracing and immobilization, and that require early powerful hand strength. Whereas IM fixation should be reserved for patients desiring a less invasive procedure and where regaining full ROM was more critical. |
| Exclusions: Open fractures, under 14 years old | ||||||
| Orbay and Touhami [26] | Locking IM fixation (95) | Usually antegrade (55) | Inclusions: Significantly displaced and unstable metaphyseal or diaphyseal fractures of the metacarpal | Radiographic measures, complications, mean operating time, ROM, grip strength, VAS for pain | III, Retrospective Comparative Study | Proximal locking broadens the indications for the reliable intramedullary fixation. |
| Fractures with 100 % displacement, rotational deformity, angulation of 60° in the 5th metacarpal, or more than 45° in the 4th metacarpal, or more than 30° in the 2nd and 3rd. | ||||||
| Exclusions: articular involvement, tendon injury, open fractures with severe soft tissue loss, and pathological fractures | ||||||
| Ozer et al. [27] | Plate screw fixation (14) | Antegrade (38) | Inclusions: Age between 19 and 49 years with closed extra- articular metacarpal fractures, rotational deformity of more than 5° for shaft fractures of the proximal third and of the middle third, lateral angulation of more than 10° in index and long fingers, 20° for ring finger, and 30° for small finger for fractures of the distal third, lateral angulation of more than 60° for small finger, 40° for index, long, and ring fingers, complete displacement of the fracture with no other associated injuries (fractures of soft tissue injuries). | ROM, DASH, radiographic measures | II, Prospective Comparative Study | IM fixation should not be used in fractures of the distal third metacarpal due to the risk of penetrating the MCP joint. |
| Exclusions: High energy injuries, open and/or comminuted fractures, previous fracture same hand | ||||||
| Schädel-Höpfner et al. [30] | Retrograde Kirschner wire pinning (15) | Antegrade (15) | Inclusions: Displaced neck fractures of the 5th metacarpal, isolated fracture | ROM, grip strength, radiographic measures, DASH, VAS for pain, Steel score | III, Retrospective Comparative Study | They prefer the antegrade IM fixation over the cross-pinning method, but thought further research to better define surgical indications in metacarpal fractures was needed. |
| Exclusions: Loss to follow-up | ||||||
| Strub et al. [33] | Conservative treatment without reduction (20) | Antegrade (20) | Inclusions: Acute, closed fractures, 5th metacarpal neck, palmar displacement between 30° and 70° | ROM, radiographic measures, VAS for pain, grip strength, and complications | II, Randomized Control Trial | Treatment should be decided on an individual basis, and IM fixation may be beneficial over conservative treatment for manual laborers. |
| Exclusions: Rotational deformity greater than 10°, concomitant injuries, open fractures, intra-articular fractures, or shaft fractures | ||||||
| Winter et al. [35] | Percutaneous transverse Kirschner wires (18) | Antegrade (18) | Inclusions: Recent, isolated, closed, simple fracture of the 5th metacarpal neck, any malrotation, palmar angulation greater than 30° | VAS for pain, ROM, grip strength, radiographic measures, patient satisfaction, complications | II, Randomized Control Trial | IM fixation technique is an efficient technique that performed better than percutaneous K-wire pinning. |
| Exclusions: Open fractures, fractures extending to metacarpal shaft, articular involvement, multiple injuries, 5th metacarpal malunion, self-inflicted injuries | ||||||
| Wong et al. [36] | Percutaneous transverse Kirschner wires (29) | Antegrade (30) | Inclusions: Closed fracture, 5th metacarpal base, more than 30° angulation | ROM, grip strength, VAS for pain, complications, radiographic measures | II, Randomized Control Study | The main complications with IM fixation were Kirschner wire migration and perforation of the metacarpal head, although they stated both are avoidable. |
| Exclusions: Angular deformity less than 30°, rotational deformity less than 15°, an open fracture, concomitant hand fractures, patients who refused surgery, less than 1 year follow-up | ||||||
| Sletten et al. [31] | Transverse Kirschner wires (45) | Antegrade (22) | Inclusions: Single, extra-articular neck and shaft fractures of the 4th and 5th metacarpals treated with bouquet or transverse pinning. Volar angulation exceeding 30°. Shaft fractures were primarily treated with closed reduction and a plaster, and surgery was indicated if the | Quick DASH, VAS for pain and satisfaction, grip strength, ROM, radiographic measures | III, Retrospective Comparative Study | Patients treated with transverse or bouquet pinning for fractures of the 4th and 5th metacarpal regain good hand function, but are at risk of surgery-related complications. Due to the risk of fracture of the neighboring metacarpal after transverse pinning, the authors concluded that bouquet pinning is superior and is now the standard at their institution. |
| fracture re-dislocated to more than 20° in the plaster in the 4th metacarpal and 25–30° in the 5th metacarpal. Patients who presented with a rotational deformity of the corresponding finger were treated operatively. | ||||||
| Exclusions: Patients younger than 18 years, patients older than 50 years, patients with fractures older than 10 days at time of surgery, patients with concomitant injuries in the ipsilateral upper limb, or previous fractures of the actual hand or wrist, patients who had a history of a previous fracture of the corresponding metacarpal in the contralateral hand. |
IM intramedullary, PS plating system, ROM range of motion, VAS visual analog scale, DASH Disabilities of the arm, shoulder and hand