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Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length

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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2 years postoperatively.

Methods

Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up.

Results

The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38 mm. Union was achieved at mean 12.3 weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05 mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis.

Conclusions

AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation.

Level of evidence

Level IV, Retrospective case series.

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Funding

This work was supported by the research fund of Chungnam National University Hospital, 2019.

Author information

Author notes

  1. SooMin Cha and JongWoo Kang are same co-first authors.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, 266 Munwha-ro, Jung-Gu, Daejeon, South Korea

    Soo Min Cha, Hyun Dae Shin, Seung Hoo Lee & Cheol Won Lee

  2. Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea

    Jong Woo Kang

Authors
  1. Soo Min Cha
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  2. Jong Woo Kang
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  3. Hyun Dae Shin
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Correspondence to Hyun Dae Shin.

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Cha, S.M., Kang, J.W., Shin, H.D. et al. Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length. Arch Orthop Trauma Surg 141, 1815–1823 (2021). https://doi.org/10.1007/s00402-021-03960-7

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