Journal List > J Korean Soc Surg Hand > v.20(4) > 1106497

J Korean Soc Surg Hand. 2015 Dec;20(4):161-167. Korean.
Published online December 31, 2015.  https://doi.org/10.12790/jkssh.2015.20.4.161
Copyright © 2015. The Korean Society for Surgery of the Hand
Modified Split Ulnar Gutter Splint for Treatment of Fifth Metacarpal Neck Fractures
Ho-Jin Gil, Yang-Guk Chung, Seung-Han Shin, Dong-Hyun Kim, Jin-Woo Kang and Sang-Hyun Jeon
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Yang-Guk Chung. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. TEL: +82-2-2258-2837, FAX: +82-2-535-9834, Email: ygchung@catholic.ac.kr
Received August 21, 2015; Revised October 08, 2015; Accepted October 10, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

To evaluate radiological results of the modified split ulnar gutter splint for the fifth metacarpal neck fracture.

Methods

Between December 2008 and May 2014, 17 patients (18 cases) with fifth metacarpal neck fractures were managed with our modified split ulnar gutter splint. Radiological outcomes in oblique and lateral radiographs were evaluated. Mean immobilization period was 4.9 weeks (range, 4-7) weeks. Mean follow-up period was 17.1 week (range, 8-80 weeks).

Results

All of 18 fractures were completely united. The average of prereduction dorsal angulation, 27° in the oblique radiographs and 21° in the lateral radiographs, were corrected to 17° in the oblique radiographs and 10° in the lateral radiographs after closed reduction. At the last follow-up, they were 14° and 11° respectively. The mean difference of angulation deformity between in postreduction and final follow-up radiograms were 3° in the oblique radiographs and 1° in the lateral radiographs, which was not significantly different.

Conclusion

Immobilization using modified split ulnar gutter splint will be a reliable option for the fifth metacarpal neck fractures in selected patients, which will avoid the surgeries.

Keywords: Fifth metacarpal neck fracture; Closed reduction; Ulnar gutter splint

Figures


Fig. 1
Reduction method under image intensifier. Longitudinal traction applied while proximal phalanx was elevated toward dorsal direction and metacarpal shaft put down.
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Fig. 2
Molding method of modified split ulnar gutter splint.
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Fig. 3
(A) A 50-year-old man sustained a fifth metacarpal neck fracture with 24.5° angulation deformity on oblique radiograph, 18° angulation on lateral radiograph. (B) Post-reduction radiographs show 14.4°, 9° residual angulation on oblique and lateral radiographs, respectively. (C) 24-month follow-up radiographs show good union without any reduction loss or rotational deformity.
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Fig. 4
(A) A 28-year-old man sustained a fifth metacarpal neck fracture with 16.5° angulation deformity on oblique radiograph, 6° angulation on lateral radiograph. (B) Post-reduction radiographs show 1.6°, 2° residual angulation on oblique and lateral radiographs, respectively. (C) 10-week follow-up radiographs show good union and 2.3°, 2° angulation on oblique and lateral radiographs, respectively.
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Tables


Table 1
Radiographic angulation in patients treated with closed reduction and ulnar gutter splint immobilization for the fifth metacarpal neck fracture
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References
1. Hunter JM, Cowen NJ. Fifth metacarpal fractures in a compensation clinic population: a report on one hundred and thirty-three cases. J Bone Joint Surg Am 1970;52:1159–1165.
2. McCue FC 3rd, Meister K. Common sports hand injuries: an overview of aetiology, management and prevention. Sports Med 1993;15:281–289.
3. Ford DJ, Ali MS, Steel WM. Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg Br 1989;14:165–167.
4. Theeuwen GA, Lemmens JA, van Niekerk JL. Conservative treatment of boxer's fracture: a retrospective analysis. Injury 1991;22:394–396.
5. Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer's fractures. J Hand Surg Am 1999;24:835–344.
6. Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 1997;99:1079–1083.
7. Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 1998;29:5–9.
8. Lowdon IM. Fractures of the metacarpal neck of the little finger. Injury 1986;17:189–192.
9. Maitra A, Sen B. Displaced boxers' fractures: a simple and effective method of external splintage. Br J Clin Pract 1990;44:348–351.
10. McKerrell J, Bowen V, Johnston G, Zondervan J. Boxer's fractures: conservative or operative management? J Trauma 1987;27:486–490.
11. Porter ML, Hodgkinson JP, Hirst P, Wharton MR, Cunliffe M. The boxers' fracture: a prospective study of functional recovery. Arch Emerg Med 1988;5:212–215.
12. Jahss SA. Fractures of the metacarpals. J Bone Joint Surg Am 1938;20:178–186.
13. Pace GI, Gendelberg D, Taylor KF. The effect of closed reduction of small finger metacarpal neck fractures on the ultimate angular deformity. J Hand Surg Am 2015;40:1582–1585.
14. Leung YL, Beredjiklian PK, Monaghan BA, Bozentka DJ. Radiographic assessment of small finger metacarpal neck fractures. J Hand Surg Am 2002;27:443–448.
15. Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am 1995;20:S86–S90.
16. Lane CS, Kennedy JF, Kuschner SH. The reverse oblique x-ray film: metacarpal fractures revealed. J Hand Surg Am 1992;17:504–506.
17. Bloem JJ. The treatment and prognosis of uncomplicated dislocated fractures of the metacarpals and phalanges. Arch Chir Neerl 1971;23:55–65.
18. Kang HJ, Song KW, Park KK, Sung SY, Hahn SB. Comparison between operative and conservative treatment of the 5th metacarpal neck fracture. J Korean Orthop Assoc 2004;39:203–209.
19. Harding IJ, Parry D, Barrington RL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg Br 2001;26:261–263.
20. Kuokkanen HO, Mulari-Keranen SK, Niskanen RO, Haapala JK, Korkala OL. Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg 1999;33:315–317.
21. Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg 2003;123:534–537.