Modified Bouquet Technique for Treatment of Metacarpal Neck Fractures

PURPOSE: The purpose of this study was to report the clinical outcome of "modified Bouquet technique", as a simple and effective internal fixation with Kirschner-wire for the metacarpal neck fractures. METHODS: Sixty-seven patients with metacarpal neck fracture treated by modified Bouquet technique were retrospectively reviewed. The operation time and removal time were evaluated. For radiologic evaluation, posterior angulation of fracture and metacarpal shortening were measured pre and postoperatively. For clinical evaluation, range of motion of metacarpophalangeal joint, Green and O'Brien score were evaluated. RESULTS: Preoperative neck shaft angle of metacarpal bone was 46.0° and length of metacarpal bone was 51.2 mm, and postoperative neck shaft angle was 24.4° (p=0.003) and length of metacarpal length was 52.8 mm (p=0.031) in average. The mean range of motion was 86.6° and Green and O'Brien score was 96.1 points at last visit. We had one complicated case with type II complex regional pain syndrome of affected hand with hypertrophic scar formation. CONCLUSION: Modified Bouquet technique for metacarpal neck fracture is a good method using just two K-wires, plier and mallet without electric devices in short operation time. The technique can correct angulation of fracture site, rotation of finger and metacarpal shortening by controlling inserted K-wires with high bone union rate with less joint stiffness.

Evaluation of the Foveal Involvement of the Ulnar Styloid Fracture: A Comparison of the Plain Radiography and Three-Dimensional Computed Tomography

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.