[Risk of Failure of Two Methods of Osteosynthesis of Fifth Metacarpal Neck Fracture].

Abstract

Purpose of the study: Fifth metacarpal neck fractures rank among the most common fractures of the hand skeleton. Only about 10% of these fractures are treated surgically. There are multiple surgical treatment options. This study aims to compare the outcomes of plate osteosynthesis with those of the "bouquet" technique.

Material and methods: Two cohorts of patients with fractures to the neck of fifth metacarpal treated at a district hospital and at a university hospital between 2017 and 2022 were evaluated, namely due to a different approach to fracture management. The district hospital cohort included 240 patients (215 men and 25 women). The mean age of patients was 31.5 years (15-91). At the university hospital, 363 patients were treated (323 men, 40 women), with a mean age of 30.3 years (16-87). In both cohorts, men outnumbered women (p < 0.0001). The exclusion criteria were age under 15 years and open fractures.

Results: There were differences between the centers in both the indications for and the performance of non-surgical and surgical treatment. At the district center, 48 patients (20%) underwent surgery. All patients were treated using the "bouquet" technique. At the university center, 27 patients (7%) underwent surgery. Two different methods were used for osteosynthesis. Plate osteosynthesis prevailed (21 patients), while the "bouquet" technique was used less frequently (6 patients). The higher proportion of patients who underwent surgery at the district center was statistically significant (p < 0.0001).

Discussion: There are no studies in the current literature that clearly give preference to one method over the others. At both centers, a volar angulation of the peripheral fragment exceeding 30° was considered a radiographic indication for surgical treatment. A high percentage of patients who underwent surgery in the district cohort was due to a different non-surgical treatment approach. The study found no difference in clinical findings after fracture healing between patients treated surgically using the "bouquet" technique and those treated with plate osteosynthesis.

Conclusions: Appropriate non-surgical treatment is essential for successful management of boxer's fractures. Physicians who treat musculoskeletal traumas should be adequately trained in this field. Where adequate non-surgical treatment is provided, only a small percentage of fractures require surgery. There are many surgical treatment options available; currently, none can be clearly recommended over the others. When comparing plate osteosynthesis and the "bouquet" technique, the authors' experience confirmed the well-known fact that displacement of fragments in the postoperative period can be prevented by adhering to all principles of good surgical practice for each treatment method.