The study outcome of bouquet technique for the management of displaced boxer's fracture
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20234043Keywords:
Boxer’s fracture, Bouquet technique, Kirschner wire, 5th metacarpal neckAbstract
Background: Fifth metacarpal neck fracture is also called Boxer's fracture. Most commonly occurs due to aggression behaviour that result in punch on a wall with a clenched first. If there is a displacement of boxer’s fracture more than 500 then it has to be managed operatively. We here present the outcome of bouquet technique that we used to operate the 80 cases of 5th metacarpal neck fracture.
Methods: We studied and did follow up of the 80, 5th metacarpal neck fracture that managed by bouquet technique. Clinical and radiological assessment was done at 4weeks and 6 weeks and 12 weeks. Total active motion, radiography and complication were noted.
Results: Out of 80 patients that were studied 72 got excellent results and 8 got fair results. Whereas one patient got infection and 2 got adventitious bursitis at the entry site which requires k wire removal.
Conclusions: The technique of antegrade intramedullary 3 kirschners wire in management of 5th metacarpal neck fracture is safe, simple, soft tissue sparing, minimally invasive technique with excellent functional and cosmetic outcome with minimal complications.
References
De Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury. 1994;25(6):365-9.
Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of metacarpal fractures in the US population. Hand (NY). 2012;7(4):426-30.
Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med. 2015;34(1):69-98.
Malik S, Herron T, Rosenberg N: Fifth Metacarpal Fractures (Boxer's Fracture). StatPearls, Treasure Island (FL); 2020.
Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthopaed Trauma Surg. 2003;123(10):534-7.
Ozturk I, Erturer E, Sahin F, Seckin F, Toker S, Uzun M, et al. Effects of fusion angle on functional results following non-operative treatment for fracture of the neck of the fifth metacarpal. Injury. 2008;39(12):1464-6.
Bansal R, Craigen MA. Fifth metacarpal neck fractures: is follow-up required. J Hand Surg (European Volume). 2007;32(1):69-73.
Hofmeister EP, Kim J, Shin AY. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. J Hand Surg. 2008;33(8):1362-8.
Jahss SA. Fractures of the metacarpals: a new method of reduction and immobilization. JBJS. 1938;20(1):178-86.
Foucher G. Bouquet! osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg. 1995;20(3):S86-90.
Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthopaed Relat Res (1976-2007). 1996;327:38-46.
Sahu A, Gujral SS, Batra S, Mills SP, Srinivasan MS. The current practice of the management of little finger metacarpal fractures-a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg. 2012;17(01):55-63.
Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998;29(1):5-9.
Kuokkanen HO, Mulari-Keränen SK, Niskanen RO, Haapala JK, Korkala OL. Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scandinav J Plast Reconstru Surg Hand Surg. 1999;33(3):315-7.
Downing ND, Davis TR. Intramedullary fixation of unstable metacarpal fractures. Hand Clinics. 2006;22(3):269-77.
Winter M, Balaguer T, Bessiere C, Carles M, Lebreton E. Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning. J Hand Surg (European Volume). 2007;32(6):709-13.
Hussain MH, Ghaffar A, Choudry Q. Iqbal Z, Khan MN. Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review. Cureus. 2020;12(7).
Padegimas EM, Warrender WJ, Jones CM, Ilyas AM. Metacarpal neck fractures: a review of surgical indications and techniques. Arch Trauma Res. 2016;5(3).
Elmowafy HM, Elsaedy Al, Hassan AM. Bouquet technique in the treatment of metacarpal fractures. Menou Med J. 2018;31(4):1312.
Weinstein LP, Hanel DP Metacarpal fractures. J Ame Soci Surg Hand. 2002;2(4):168-80.
Rollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand. 2014;9(1):16-23.
Fujitani R, Omokawa S, Shigematsu K, Tanaka Y. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci. 2012;17(4):450-6.
Lee SK, Kim KJ, Choy WS. Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures. Euro J Orthopaed Surg Traumatol. 2013;123(5):535-43.
Manueddu CA, DellaSanta D. Fasciculated intramedullary pinning of metacarpal fractures. J Hand Surg: Brit Euro. 1996;21(2):230-6.
Galal S, Safwat W. Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient- reported outcome. J Clin Orthop Trauma. 2017;8(4):339-43.
Hunter JM, Cowen NJ. Fifth metacarpal fractures in a compensation clinic population: a report on one hundred and thirty-three cases. JBJS. 1970;52(6):1159-65.
Boussakri H, Elidrissi M. Azarkane M. Bensaad S, Bachiri M, Shimi M, et al. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing surgical technique, radiological and clinical results study (28 cases). Pan African Medi J. 2014;18:187.
