![]() ![]() Thus, it is valuable to find how to improve the locking plate fixation without insertion of K-wires.įeatures of internal fixation including number of distal and proximal locking screws, diameter of the screws and usage of lag screws is associated with the strength of fixation and therefore may affect the secondary displacement and prognosis 14. ![]() In addition, pin tract infection was also a major complication after K-wire fixation 13. However, percutaneous K-wire fixation could also lead to an increase in surficial infection and irrigation of skin 12. We therefore showed that locking plate in combination with two crossed K-wires could decrease the secondary displacement in volar angulation compared with fixation with locking plate alone in previous study 11. The secondary displacement in volar angulation was frequently observed after locking plate fixation, highlighting the need for improvement. A meta-analysis of six studies recommended locking plate as first-line choice of operative fixation 10. A range of surgical techniques have been described for the treatment of fifth metacarpal neck fracture: intramedullary K-wires 3, transverse K-wires 4, tension band 5, locked intramedullary nailing 6, external fixation 7, and locking plate fixation 8, 9. A biomechanical study showed that final volar angulation more than 30 degrees could lead to decreased ROM of fifth metacarpophalangeal joint and functional impairment 2. The fifth metacarpal neck fracture accounts for approximately 20% of all fractures in hand 1. In conclusion, the metacarpal head should be fixed by three locking screws instead of two locking screws. Consistently, three-screw fixation of distal fragment could improve the prognosis compared with two-screw fixation (MHQ 95.4 ± 5.1 versus 80.4 ± 12.3, ROM 83.5 ± 7.2 versus 69.6 ± 7.7). Three-screw fixation was less frequently presented in the group with increased volar angulation (≥30 degrees). Clinical and radiographic outcomes included final volar angulation, grip strength, Michigan Hand Outcomes Questionnaire (MHQ) and range of motion (ROM) of fifth metacarpophalangeal joint. Features of internal fixation including number of distal and proximal locking screws, diameter of the screws and usage of lag screws were recorded. Patients with fifth metacarpal neck fracture receiving locking plate fixation were included for analysis. Locking plate was widely adopted in the treatment of fifth metacarpal neck fracture as first-line choice for fixation. Fifth metacarpal neck fracture commonly requires open reduction and internal fixation. ![]()
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