J Korean Soc Surg Hand.  2016 Sep;21(3):137-143. 10.12790/jkssh.2016.21.3.137.

Modified Bouquet Technique for Treatment of Metacarpal Neck Fractures

• Sung YG
• Song SW
• Lee YM

• KMID: 2353818
• DOI: http://doi.org/10.12790/jkssh.2016.21.3.137

Abstract

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.

Keyword

Metacarpal; Neck fracture; Anterograde intramedullary fixation; Modified Bouquet technique

MeSH Terms

Causalgia
Cicatrix, Hypertrophic
Fingers
Hand
Humans
Joints
Metacarpophalangeal Joint
Methods
Neck*
Range of Motion, Articular
Retrospective Studies

Figure

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  Fig. 1. Surgical instruments: one 1.6 mm K-wire, two 1.25 mm K-wires, plier, mallet and wire-cutter.

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  Fig. 2. Surgical procedure. (A) Insert 1.6 mm K-wire to make entry hole for insertion of prebent K-wires at dorsoulnar aspect of metacarpal base. (B) Rotate the K-wire for widening the hole. (C) Two 1.25 mm K-wires were prebent before insertion. (D) Inserted prebent K-wire through the hole using plier and mallet. (E) Advance two K-wires distally. (F) Reduce the fracture site by rotating K-wires. (G) Cut K-wires as short as possible to bury the tips beneath skin.

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  Fig. 3. A 65-year-old male patient with right hand pain (A) Initial anteroposterior and oblique plain X-ray show oblique fracture of 5th metacarpal neck. (B) After fixation by modified Bouquet technique, fracture is reduced successfully. (C) Plain radiographs in postoperative 7 weeks show nearly complete union state with normal length and shape.

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