Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study

Aita, Marcio Aurelio; Oliveira, Ricardo Kaempf de; Biondi, Bruno Gianordoli; Brunelli, João Pedro Farina; Ruggiero, Gustavo Mantovanni; Delgado, Pedro Jose

doi:10.1055/s-0041-1729568

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Original Article • Rev. bras. ortop. 56 (06) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1729568 copy

Intramedullary Fixation with Headless Screws versus Bouquet in Unstable Metacarpal Neck Fractures in Active Patients: A Randomized Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objeticve

To compare the range of motion (ROM), return-to-work time, visual analogue score (VAS), disability of the arm, shoulder, and hand (QuickDASH), and radiographic outcomes of two methods of definitive internal fixation in active patients with boxer’s fractures, operated in the first week.

Methods

This was a prospective, randomized trial, in which 50 patients, with a mean age range of 18 to 40 years old, were randomized and treated to definitive intramedullary fixation using 2 headless screws (n = 20) or bouquet (2 or 3 Kirschner wires) (n = 20). The patients were assessed on return-to-work time, ROM, patient reported QuickDASH outcome, VAS, and radiographic evaluation at 6 months.

Results

At 6 months, there were no differences between the two groups in terms of ROM, postoperative pain (VAS), or QuickDASH score. The overall complication rate was 4.76% in the screw group, compared with 5% in the bouquet-fixation group.

Conclusions

In the treatment of the active patients with unstable boxer’s fractures, headless screws and bouquet fixation proved to be a safe and reliable treatment. The outcomes were similar in both groups.

Keywords
metacarpal bones; boxer’s fracture; fracture fixation; intramedullary; minimally invasive surgical procedures; clinical trials; randomized

ID	Age	Follow-up	Side	Final ROM %	QuickDASH	Pain VAS	Return to work (days)	Complications	Other surgery
1	25	19	R	100	11.36	1	90	Y	Y
2	23	25	R	100	0	0	60	N	N
3	32	21	L	100	0	0	10	N	N
4	21	17	R	100	2.27	1	30	N	N
5	35	8	R	100	0	0	15	N	N
6	54	13	R	100	4.54	2	30	N	N
7	25	19	L	100	0	0	60	N	N
8	27	25	L	100	0	0	15	N	N
9	28	17	R	100	0	0	30	N	N
10	35	11	R	100	0	0	20	N	N
11	21	16	R	100	2.27	0	20	N	N
12	36	19	R	100	0	0	15	N	N
13	26	7	L	100	2.27	0	30	N	N
14	30	13	R	100	0	0	30	N	N
15	51	8	L	75	0	0	5	N	N
16	27	11	R	100	0	0	20	N	N
17	42	9	L	100	0	1	60	N	N
18	34	13	R	100	0	0	45	N	N
19	21	10	R	100	2.27	0	15	N	N
20	31	11	R	100	0	0	30	N	N

ID	Age	Follow-up	Side	Final ROM %	QuickDASH	Pain VAS	Return to work (days)	Complications	Other surgery
1	36	15	L	100	4.54	1	82	N	N
2	28	12	R	100	0	0	13	N	N
3	52	12	R	100	0	1	37	N	N
4	41	11	R	100	2.27	0	43	N	N
5	18	11	R	100	0	0	11	N	N
6	28	11	R	100	2.27	1	71	N	N
7	28	11	R	100	4.54	1	64	N	N
8	27	10	R	100	0	1	44	N	N
9	16	9	R	100	0	0	14	N	N
10	42	8	L	100	0	1	28	N	N
11	38	8	R	100	0	0	11	N	N
12	24	7	R	100	0	1	37	N	N
13	34	6	L	100	2.27	0	51	N	N
14	29	6	R	100	0	0	48	N	N
15	19	6	L	100	0		37	N	N
16	21	6	R	75	15.9	3	54	Y	N
17	29	6	L	100	0	0	10	N	N
18	29	6	R	100	0	0	7	N	N
19	41	6	R	100	0	0	6	N	N
20	23	6	R	100	0	0	13	N	N
21	22	6	R	100	0	0	9	N	N

		GROUP				Sig. (p)
		A (K-wire)		B (screw)
		Freq.	Perc.	Freq.	Perc.
Side	L R	6 14	30% 70%	5 16	23.8% 76.2%	0.655
Complications	Y N	1 19	5% 95%	1 21	4.76% 95.25%	0.627
Other surgery	Y N	1 19	5% 95%	0 21	0% 100%	0.300

Variable	Group	n	Man	Standard deviation	Min	Max	Perc. 25	Perc. 50 (median)	Perc. 75	Sig. (p)
Age (years)	A	20	31.20	9.23	21	54	25	29	35	0.715
	B	21	29.76	9.22	16	52	22.5	28	37
	Total	41	30.46	9.14	16	54	23.5	28	35.5
Follow-up (months)	A	20	14.6	5.49	7	25	10.25	13	19	< 0.001
	B	21	8.52	2.77	6	15	6	08	11
	Total	41	11.49	5.25	6	25	7	11	14
ROM (% opposite side)	A	20	98.75	5.59	75	100	100	100	100	0.972
	B	21	98.81	5.46	75	100	100	100	100
	Total	41	98.78	5.45	75	100	100	100	100
Quick DASH	A	20	1.25	2.71	0	11.36	0	0	2.27	1
	B	21	1.51	3.62	0	15.9	0	0	2.27
	Total	41	1.38	3.17	0	15.9	0	0	2.27
VAS	A	20	0.25	0.55	0	2	0	0	0	0.14
	B	21	0.52	0.75	0	3	0	0	1
	Total	41	0.39	0.67	0	3	0	0	1
Return to work (days)	A B	20 21	31.5 32.86	21.41 23.16	5 6	90 82	15 11	30 37	41.25 49.5	0.865
	Total	41	32.20	22.05	5	90	13.5	30	46.5

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E-mail: rbo@sbot.org.br

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[1] Endereço para correspondência Marcio A. Aita, MD, PhD, Division of Hand and Microsurgery, Department of Orthopedics and Trauma, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Príncipe de Gales, Santo André, SP 09060-650, Brazil (e-mail: marcioaita@me.com).