Efficacy Comparison Of Antergrade Intramedullary K-wire Fixation And Retrograde Cross K-wire Fixation For Unstable Fifth Metacarpal Neck Fractures

Objective: The objective of this study was to compare the results of treatment of unstable fifth metacarpal neck fractures using antegrade intramedullary K-wire fixation and retrograde cross K-wire fixation.Methods: A retrospective analysis was used.Thirty patients who were diagnosed as unstable fifth metacarpal neck fracture treated with antegrade intramedullary K-wire fixation or retrograde cross K-wire fixation in our hospital from January 2017 to September 2019 were enrolled in the study in two group: antegrade intramedullary K-wire fixation group and retrograde cross K-wire fixation group.Every group contains15 patients.Resetting result of fracture,postoperative complications,head/shaft angle before and after surgery of the treated side,head/shaft angle of healthy-side,joint range of motion includes flexion and extension of the treated side in different follow-up time and joint range of motion of healthy-side were used to assess patient's objective curative effect.DASH score in different follow-up time was used to assess patient's subjective curative effect.Results:(1)The patients in both groups all recovered well after surgery without any complications.(2)There was no significant difference in the rate of reaching anatomical reduction and resetting result of fracture between two groups.(3)At 4 months after surgery,functional recovery of the patients who treated with antegrade intramedullary K-wire fixation was better than the patients who treated with retrograde cross K-wire fixation.But the joint range of motion of the two groups cannot recover to the healthy-side.At 6 months after surgery,there was no significant difference in the function between two groups.As well as there was no significant difference in the joint range of motion between treated side and healthy-side.(4)At 4 months after surgery,DASH scores of the patients who treated with antegrade intramedullary K-wire fixation was less than the patients who treated with retrograde cross K-wire fixation.At 6 months after surgery,DASH scores of the two groups are basically the same.Conclusions: The treatment effect of antegrade intramedullary K-wire fixation is better than the treatment effect of retrograde cross K-wire fixation in short term after surgery.However,We also found that these two treatment of the unstable fifth metacarpal neck fracture were not only nearly reach the same result in the end but also both of them could recover to the level of the healthy hand.The operation of retrograde cross K-wire fixation is simpler than that of antegrade intramedullary K-wire fixation.What's more,it is easier to remove the K-wire after surgery by the way of retrograde cross K-wire fixation than antegrade intramedullary K-wire fixation.Considering these,the author recommends using the retrograde cross K-wire fixation to treat the unstable fifth metacarpal neck fracture.