SYSTEMATIC REVIEW ON ANTEGRADE INTRAMEDULLARY PINNING VERSUS RETROGRADE INTRAMEDULLARY PINNING IN BOXER`S FRACTURE (A SYSTEMATIC REVIEW)

Background: The literature is limited concerning the issues of fracture in the fifth metacarpal bone with no robust evidence for the best treatment practice for metacarpal neck fractures. The purpose of this review was to investigate whether the ante grade intramedullary k-wires compared to retrograde intramedullary k-wires results in good clinical and radiological outcomes for displaced metacarpal neck fractures.
Aim of the Work: To perform a comparative systematic review to determine whether there is a significant difference in the clinical outcome and complication between ante grade and retrograde intramedullary nailing of fracture neck in Boxer's fracture.
Patients and Methods: We searched in four different databases for the relevant articles including PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials (CENTRAL) till October 2020. We included randomized controlled trials (RCTs), comparative studies, prospective cohort, or retrospective charts studies that compared ante grade intramedullary k-wires to retrograde intramedullary k-wires in displaced fifth metacarpal bone. Our primary outcome was ROM, Grip strength, DASH and VAS. Our secondary outcomes were complication rates and other outcomes that were consistently reported across studies.
Results: From a total 224 screened citations, three studies met our inclusion criteria. All three studies reported that ante grade intramedullary pinning was superior to retrograde intramedullary pinning in term of ROM, VAS, grip strength, DASH scores and early return to work. Also ante grade intramedullary pinning had better satisfaction in terms of comfort and tenderness. But some theses clinical parameters become statistically non-significant between both methods with long duration of follow up. Both techniques had similar radiographic outcomes and improvement in preoperative angulation and shortening. We highlighted the need for a standardization of the outcomes across studies and the need for larger studies the compare between both techniques.
Conclusion: Ante grade intramedullary k-wires is superior to retrograde intramedullary k-wires regarding early restoration of hand movement in the short term follow up.