Vol.:(0123456789) 1 3 European Journal of Trauma and Emergency Surgery https://doi.org/10.1007/s00068-018-01073-2 ORIGINAL ARTICLE A single antegrade intramedullary k-wire for ffth metacarpal neck fractures Chahine Assi 1  · Jad Mansour 1  · Camille Samaha 1  · Sleiman Ajjoub 1  · Kaissar Yammine 1 Received: 15 October 2018 / Accepted: 31 December 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Objectives Antegrade intramedullary nailing (AIMN) using 2k-wires seems to be superior to other modalities in treating displaced fractures of the ffth metacarpal neck (FFMN). Few reports demonstrated similar results retrospective with a single k-wire. The aim of the study is to describe our single k-wire technique and evaluate the related results. Methods This is a retrospective study of a continuous series of patients treated with a single intramedullary k-wire for FFMN. It includes 30 patients who met the criteria for surgery: a dorsal angulation of more than 30°, malrotation, or both. The mean clinical follow-up period was 7 ± 14.9 months. Results The mean pre-operative angle was 50° ± 11.35° and the mean immediate post-operative angle was 4.86° ± 2.8°. The mean immediate correction was 47° ± 9.3°. The mean correction at last follow-up was 45.14° ± 8.55°. Healing was obtained in all patients and bone union was achieved at a mean of 5.6 ± 1.2 weeks. The mean operative time was 8.5 min. The mean C-arm usage (number of clicks) was 7.2 times. The mean exposure radiation time was calculated at 3.6 s. The mean radiation dose was 0.08 mGy/mm 2 . The mean satisfaction score was 1.26 ± 0.45. Quick-DASH and EQ-5D scores yielded excellent values. Conclusions With potential benefts like lesser surgical time, radiation and cost, the use of a single AIMN could be safer, quicker and cheaper while reproducing similar clinical, functional and radiological outcomes to those reported with the use of 2k-wires. Keywords Fifth metacarpal neck fracture · Single antegrade elastic nailing · Surgery Introduction Fractures of the ffth metacarpal neck account for nearly 25% of all metacarpal fractures and are considered the most common type of hand fractures [1–3]. The majority of ffth metacarpal neck fractures are simple, isolated and are treated conservatively [4, 5]. However, an inappropriate treatment of these fractures could lead to a decrease in the range of motion of the metacarpophalangeal (MCP) joint, an unsightly deformity of the distal aspect of the ffth metacar- pal (M5), and a decrease in the grip strength [6, 7]. Malrota- tion and an excessive dorsal angulation are usually indica- tions for surgery. The tolerable limit of dorsal angulation varies between authors; above 30° [8] to above 45° [9, 10]. The surgical management of these fractures remains contro- versial and varies widely [11, 12]. Many surgical modali- ties have been described for the treatment of these fractures including antegrade intramedullary nailing (AIMN) using 2k-wires [13–18], transverse k-wires pinning [13, 19], low- profle plates [17, 20] and external fxation [21]. Recently, the use of two AIMN has gained attractiveness owing to being relatively simple, minimally invasive and cost-efec- tive with reports of good to excellent clinical outcomes [1, 22, 23]. A meta-analysis conducted by Yammine et al. [23] reported signifcantly better short- and mid-term clinical and radiological outcomes when using the antegrade intramed- ullary nailing with the advantage of fewer complications. We could fnd six papers, all recent, reporting the use of a single AIMN in the treatment of such fractures [24–29]. These authors demonstrated good-to-excellent outcomes using such technique. Therefore, the aim of this study is to determine whether the use of a single AIMN would repro- duce similar outcomes as those published in the literature. * Kaissar Yammine cesaryam@gmail.com 1 Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Zahra Street, Achrafeh, Beirut, Lebanon