Surgical treatment of the Boxer’s fracture: Transverse pinning versus Intramedullary Pinning

Boxer's fractures are common injuries in the hand. They are fractures of the neck of the fifth metacarpal, and typically occur in young, active men who sustain injury as a result of direct, blunt trauma.
This study looks to compare the differences between transverse pinning and intramedullary pinning (using the Bouquet technique), as both surgical procedures are known to be effective.
It is not clear from this study, how patients were allocated to each group, or whether it was a randomized trial.

36 patients with an inclusion criterion of a recent, isolated, closed and simple fracture of the neck of the fifth metacarpal bone were recruited during a period of 12 months.
18 patients were surgically treated by transverse pinning, using two k-wires, each with a diameter of 1.5mm. The remaining 18 patients were treated by intramedullary pinning, using three k-wires, each with a diameter of 1mm.
All patients were placed into a palmer splint post-operatively for one week, to assist healing of the soft tissues and avoid post-operative displacement of the fracture.
Patients were clinically evaluated post-operatively using X-ray assessment on days 8, 15, 30, 45, 60 and 90.
Pain was measured using the Visual Analogue scale (VAS), and active and passive range of movement was also assessed by a physiotherapist. Patients' grip strength was also measured using dynamometer.

Results showed all patients fractures had united within six weeks, and all achieved full extension of their little finger.
However, there was a significant difference between the two procedures with regards to achieving active and passive range of movement, with the better result coming from patients that were treated using intramedullary pinning.
Grip strength was also found to be stronger in the group that received intramedullary pinning, however this difference was not found to be as statistically significant compared with the range of movement.
At the final follow up, only two patients who were treated using transverse pinning reported residual pain.

The authors report that although intramedullary pinning is more demanding than transverse pinning, results show a more functional improvement.

In Mike Hayton's practice, his preferred technique of fixation is a single 1.6mm bent antegrade intramedullary k-wire for those fractures that require intervention. He has used this technique for a number of years and finds it a simple and relatively non invasive method of providing stability.

Winter, M., Balaguer, T., Bessiere., C., Carles, M and Lebreton. E
Journal of Hand Surgery (European Volume, 2007) 32E: 6: 709-713