Retrospective comparative analysis between intramedullary kirschner wire fixation and conservative treatment for displaced 5th metacarpal neck fractures

Purpose

The study aimed to compare the short and long-term functional outcomes of the displaced 5th metacarpal neck fractures treated by conservative and intramedullary Kirschner wire fixation.

Methods

A retrospective cohort study was conducted between 2016 and 2018, analyzing 41 patients with displaced 5th metacarpal neck fractures. The patients were divided into surgical (intramedullary Kirschner wire fixation) and conservative groups (no fracture reduction, plaster of paris immobilization, and followed with a functional brace). The functional outcome was assessed and compared at six weeks and 12 months of follow-up.

Results

There were 22 patients in the surgical group and 19 in the conservative group. All fractures united in both groups. The age, gender, flexion, extension at the MCP joint, grip strength, VAS, time to union, and return to work were comparable between the two groups. There was no significant difference in the outcome at six weeks and 12 months between surgical and conservative groups. The surgical group's quick DASH score was significantly better (p < 0.05). The radiological outcomes (palmar angulation, shortening) improved in the surgical group but persisted in the conservative groups in the follow-up.

Conclusions

The displaced 5th metacarpal neck fractures managed by intramedullary or conservative with a functional brace produce similar functional results. The patient's satisfaction, aesthetics, and functionality are superior in the surgical group.

Level of evidence

IV.