Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

Introduction: Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45 degrees and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. Hypothesis: The present study compared results between locking plates and intramedullary K-wires. Material and methods: The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). Results: No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). Discussion: Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks' immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. Level of evidence: Level IV continuous prospective comparative study. (C) 2010 Elsevier Masson SAS. All rights reserved.