Early- and mid-term effectiveness of bilateral bracing using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame for treatment of metacarpal shaft fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Teng ¹ , JI Liang ¹ , WANG Xiang ¹ , ZHANG Bowei ¹ , TAO Lei ¹ , DONG Yang ¹ , LIU Yang ² ,  SHU Tao ³

1. Department of Hand Microsurgery, the Fourth People’s Hospital of Guiyang, Guiyang Guizhou, 550002, P. R. China;
2. Department of Orthopaedics, First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang Guizhou, 550000, P. R. China;
3. Department of Orthopaedic Surgery, Guizhou Hospital, Beijing Jishuitan Hospital, Guiyang Guizhou, 550014, P. R. China;

Corresponding?author：

SHU Tao, Email: 2602580396@qq.com

Keywords：

Metacarpal shaft fracture; closed reduction; cemented external frame; bilateral bracing

DOI：

10.7507/1002-1892.202602050

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To study the early- and mid-term effectiveness of closed reduction and bilateral bracing using percutaneous pinning supported by adjacent metacarpal bones and a cemented external fixator for treatment of metacarpal shaft fractures. Methods Between April 2022 and June 2024, 18 patients with metacarpal shaft fractures were treated with closed reduction and bilateral bracing fixation using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame. Of these, 16 were male and 2 were female; their ages ranged from 18 to 47 years (mean, 30.6 years). The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.4 days). Fracture sites were the second metacarpal bone in 5 cases, the fifth metacarpal bone in 10 cases, the fourth and fifth metacarpal bones in 2 cases, and the second to fifth metacarpal bones in 1 case. There were 4 cases of transverse fractures, 10 cases of oblique fractures, and 4 cases of comminuted fractures. The frequency of intraoperative fluoroscopy, operation time, length of hospital stay, time to fracture union, and visual analogue scale (VAS) scores for pain at 1 day before operation and 3 days after operation were recorded. At last follow-up, the range of motion of the metacarpophalangeal joint and the grip strength of the affected hand were measured, and the function of the affected hand was assessed according to the criteria for upper limb functional assessment issued by the Chinese Medical Association Hand Surgery Society. Results The operation time ranged from 38 to 70 minutes (mean, 49.3 minutes); intraoperative fluoroscopy was performed between 4 and 12 times (mean, 6.9 times); and the length of hospital stay ranged from 4 to 9 days (mean, 6.4 days). The VAS score at 3 days after operation was 2 (1, 2), which was significantly lower than the score recorded at 1 day before operation [5 (4, 6)] (Z=?3.866, P<0.001). Three patients experienced slight leakage at the puncture site, and 2 had mild difficulty in extending joints. All patients were followed up 6-8 months (mean, 7.1 months). Imaging follow-up revealed that all fractures had healed, with a healing time ranging from 48 to 72 days (mean, 62.0 days). At last follow-up, the range of motion of the metacarpophalangeal joint was 78°-90° (mean, 86.1°); grip strength in the affected hand reached 80% to 98% of that in the unaffected hand, with a mean of 91.8%. According to the criteria for upper limb functional assessment issued by the Chinese Medical Association Hand Surgery Society, the function was rated as excellent in 6 cases, good in 10 cases, and fair in 2 cases, with an excellent and good rate of 88.9%. Conclusion The treatment of metacarpal shaft fractures using closed reduction and bilateral bracing fixation using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame offers advantages, such as minimal trauma, relatively simple technique, and ease of internal fixation removal. It yields satisfactory early- to mid-term effectiveness; however, strict adherence to surgical indications is required.

Citation： WANG Teng, JI Liang, WANG Xiang, ZHANG Bowei, TAO Lei, DONG Yang, LIU Yang, SHU Tao. Early- and mid-term effectiveness of bilateral bracing using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame for treatment of metacarpal shaft fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1075-1079. doi: 10.7507/1002-1892.202602050 Copy

1.	Taha R, Davis T, Montgomery A, et al. Management of metacarpal shaft fractures. Bone Jt Open, 2024, 5(8): 652-661.
2.	Carre?o A, Ansari MT, Malhotra R. Management of metacarpal fractures. J Clin Orthop Trauma, 2020, 11(4): 554-561.
3.	Kollitz KM, Hammert WC, Vedder NB, et al. Metacarpal fractures: treatment and complications. Hand (N Y), 2014, 9(1): 16-23.
4.	Lazarus P, Hidalgo Diaz JJ, Xaxier F, et al. Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning. Eur J Orthop Surg Traumatol, 2020, 30(3): 425-433.
5.	明立功, 明朝戈, 王自方, 等. 經皮克氏針橫行平行或交叉支撐固定治療第五掌骨頸骨折. 中國修復重建外科雜志, 2020, 34(2): 272-274.
6.	Lambi AG, Rowland RJ, Brady NW, et al. Metacarpal fractures. J Hand Surg (Eur Vol), 2023, 48(2_suppl): 42S-50S.
7.	Ahmed SH, Shekouhi R, Kardan R, et al. Outcomes of metacarpal fracture fixation with intramedullary nails: a systematic review. Annals of Plastic Surgery, 2025, 94(6S Suppl 4): S486-S492.
8.	Fusetti C, Meyer H, Borisch N, et al. Complications of plate fixation in metacarpal fractures. J Trauma, 2002, 52(3): 535-539.
9.	Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg (Am), 1998, 23(5): 827-832.
10.	Wang K, Du W, Deng C, et al. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. J Int Med Res, 2023, 51(5): 3000605231174981. doi: 10.1177/03000605231174981.
11.	Bigorre N. Complications of osteosynthesis for long-finger metacarpal and phalanx fracture. Hand Surg Rehabil, 2024, 43(4): 101746. doi: 10.1016/j.hansur.2024.101746.
12.	季亮, 胡興峰, 張博偉, 等. 微型鋼板與灌注骨水泥外固定架治療第5掌骨頸骨折. 中國矯形外科雜志, 2020, 28(14): 1328-1330.
13.	潘生德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14.	Eisenschenk A, Spitzmüller R, Güthoff C, et al. Single versus dual Kirschner wires for closed reduction and intramedullary nailing of displaced fractures of the fifth metacarpal neck (1-2 KiWi): a randomized controlled trial. Bone Joint J, 2019, 101-B(10): 1263-1271.
15.	Stash N, Kamal RN, Richard M, et al. Metacarpal fractures: An evidence-based review to guide treatment. J Am Acad Orthop Surg, 2025, 33: 1361-1371.
16.	Cavalcanti KA, Kuehlein T, Langer MF, et al. The treatment of closed finger and metacarpal fractures. Dtsch Arztebl Int, 2023, 120(50): 855-862.
17.	Beaumont CM, Beason DP, McKeon KE. Fracture fixation strength in metacarpal plating versus intramedullary nailing using a 3-point bending model: a cadaveric, biomechanical study. J Hand Surg (Am), 2024, 49(1): 57.e1-57.e6.
18.	褚庭綱, 周宗偉, 薛繼鑫, 等. 外置接骨板、克氏針與外固定支架治療開放性掌骨骨折的比較研究. 中華手外科雜志, 2019, 35(5): 321-324.
19.	張政, 張岱捷, 李朋. 經皮克氏針橫行固定與微型鋼板置入治療第五掌骨干骨折的比較. 中國組織工程研究, 2024, 28(30): 4842-4847.
20.	李廣磊, 郭清皓. 克氏針橫向穿針內固定治療掌骨骨折的療效分析. 中華手外科雜志, 2026, 42(1): 35-37.

1. Taha R, Davis T, Montgomery A, et al. Management of metacarpal shaft fractures. Bone Jt Open, 2024, 5(8): 652-661.
2. Carre?o A, Ansari MT, Malhotra R. Management of metacarpal fractures. J Clin Orthop Trauma, 2020, 11(4): 554-561.
3. Kollitz KM, Hammert WC, Vedder NB, et al. Metacarpal fractures: treatment and complications. Hand (N Y), 2014, 9(1): 16-23.
4. Lazarus P, Hidalgo Diaz JJ, Xaxier F, et al. Transverse and oblique fractures of the diaphysis of the fifth metacarpal: surgical outcomes for antegrade intramedullary pinning versus combined antegrade and retrograde intramedullary pinning. Eur J Orthop Surg Traumatol, 2020, 30(3): 425-433.
5. 明立功, 明朝戈, 王自方, 等. 經皮克氏針橫行平行或交叉支撐固定治療第五掌骨頸骨折. 中國修復重建外科雜志, 2020, 34(2): 272-274.
6. Lambi AG, Rowland RJ, Brady NW, et al. Metacarpal fractures. J Hand Surg (Eur Vol), 2023, 48(2_suppl): 42S-50S.
7. Ahmed SH, Shekouhi R, Kardan R, et al. Outcomes of metacarpal fracture fixation with intramedullary nails: a systematic review. Annals of Plastic Surgery, 2025, 94(6S Suppl 4): S486-S492.
8. Fusetti C, Meyer H, Borisch N, et al. Complications of plate fixation in metacarpal fractures. J Trauma, 2002, 52(3): 535-539.
9. Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg (Am), 1998, 23(5): 827-832.
10. Wang K, Du W, Deng C, et al. Treatment of fifth metacarpal neck fracture in adolescents with minimally invasive surgery: percutaneous Kirschner wire fixation versus elastic stable intramedullary nailing. J Int Med Res, 2023, 51(5): 3000605231174981. doi: 10.1177/03000605231174981.
11. Bigorre N. Complications of osteosynthesis for long-finger metacarpal and phalanx fracture. Hand Surg Rehabil, 2024, 43(4): 101746. doi: 10.1016/j.hansur.2024.101746.
12. 季亮, 胡興峰, 張博偉, 等. 微型鋼板與灌注骨水泥外固定架治療第5掌骨頸骨折. 中國矯形外科雜志, 2020, 28(14): 1328-1330.
13. 潘生德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14. Eisenschenk A, Spitzmüller R, Güthoff C, et al. Single versus dual Kirschner wires for closed reduction and intramedullary nailing of displaced fractures of the fifth metacarpal neck (1-2 KiWi): a randomized controlled trial. Bone Joint J, 2019, 101-B(10): 1263-1271.
15. Stash N, Kamal RN, Richard M, et al. Metacarpal fractures: An evidence-based review to guide treatment. J Am Acad Orthop Surg, 2025, 33: 1361-1371.
16. Cavalcanti KA, Kuehlein T, Langer MF, et al. The treatment of closed finger and metacarpal fractures. Dtsch Arztebl Int, 2023, 120(50): 855-862.
17. Beaumont CM, Beason DP, McKeon KE. Fracture fixation strength in metacarpal plating versus intramedullary nailing using a 3-point bending model: a cadaveric, biomechanical study. J Hand Surg (Am), 2024, 49(1): 57.e1-57.e6.
18. 褚庭綱, 周宗偉, 薛繼鑫, 等. 外置接骨板、克氏針與外固定支架治療開放性掌骨骨折的比較研究. 中華手外科雜志, 2019, 35(5): 321-324.
19. 張政, 張岱捷, 李朋. 經皮克氏針橫行固定與微型鋼板置入治療第五掌骨干骨折的比較. 中國組織工程研究, 2024, 28(30): 4842-4847.
20. 李廣磊, 郭清皓. 克氏針橫向穿針內固定治療掌骨骨折的療效分析. 中華手外科雜志, 2026, 42(1): 35-37.

Chinese Journal of Reparative and Reconstructive Surgery

Early- and mid-term effectiveness of bilateral bracing using percutaneous pinning supported by adjacent metacarpal bones and a cemented external frame for treatment of metacarpal shaft fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content