髓内固定微创治疗第五掌骨远端骨折的研究进展
Research Progress on Minimally Invasive Intramedullary Fixation in the Treatment of Distal Fifth Metacarpal Fracture
DOI: 10.12677/acm.2026.162367, PDF,   
作者: 吴海林, 蒋煜文*：暨南大学珠海临床医学院(珠海市人民医院，北京理工大学附属医院创伤骨科)，广东 珠海
关键词: 第五掌骨远端骨折；骨折固定术；微创；髓内固定；Distal Fifth Metacarpal Fracture； Fracture Fixation； Minimally Invasive； Intramedullary Fixation
摘要: 第五掌骨远端骨折(distal fifth metacarpal fracture, DFMF)多发生于头颈交界区，常伴背侧成角。治疗旨在恢复对位对线、稳定固定、促进骨愈合并维持关节活动度，以避免掌指关节功能障碍。目前治疗方法多样，尚无金标准。对于移位明显、不稳定的骨折，往往需要手术治疗，其中髓内固定微创技术因其操作简便、软组织损伤小等优点日益受到关注。本文聚焦于髓内固定技术在第五掌骨远端骨折中的应用，通过系统回顾相关文献，重点分析各类髓内固定技术的操作要点、临床疗效，辅以示意图，并总结其优缺点，期望为第五掌骨远端骨折的患者获得更好的临床疗效提供一定的参考和帮助。
Abstract: Distal fifth metacarpal fractures (DFMF) typically occur at the head-neck junction and are frequently associated with dorsal angulation. Treatment aims to restore anatomical alignment, achieve stable fixation, promote bone healing, and preserve joint mobility to prevent metacarpophalangeal joint dysfunction. Currently, various treatment methods are available, with no established gold standard. For significantly displaced or unstable fractures, surgical intervention is often necessary. Among surgical options, minimally invasive intramedullary fixation techniques have gained increasing attention due to their procedural simplicity and minimal soft tissue disruption. This article focuses on the application of intramedullary fixation techniques for DFMF. Through a systematic review of relevant literature, it analyzes the key technical aspects and clinical outcomes of various intramedullary fixation methods, supported by schematic diagrams, and summarizes their advantages and limitations. The goal is to provide valuable references and insights to help achieve better clinical outcomes for patients with distal fifth metacarpal fractures.
文章引用：吴海林, 蒋煜文. 髓内固定微创治疗第五掌骨远端骨折的研究进展[J]. 临床医学进展, 2026, 16(2): 109-114. https://doi.org/10.12677/acm.2026.162367

参考文献

[1] Malik, S., Herron, T., Taqi, M. and Rosenberg, N. (2025) Fifth Metacarpal Fracture. StatPearls.
[2] Hussain, M.H., Ghaffar, A., Choudry, Q., Iqbal, Z. and Khan, M.N. (2020) Management of Fifth Metacarpal Neck Fracture (Boxer’s Fracture): A Literature Review. Cureus, 12, e9442. [Google Scholar] [CrossRef] [PubMed]
[3] Diaz-Garcia, R. and Waljee, J.F. (2013) Current Management of Metacarpal Fractures. Hand Clinics, 29, 507-518. [Google Scholar] [CrossRef] [PubMed]
[4] Nakashian, M.N., Pointer, L., Owens, B.D. and Wolf, J.M. (2012) Incidence of Metacarpal Fractures in the US Population. Hand, 7, 426-430. [Google Scholar] [CrossRef] [PubMed]
[5] Baumgartner, R.E., Federer, A.E., Guerrero, E.M., Mithani, S.K., Ruch, D.S. and Richard, M.J. (2021) Complications of Low-Profile Plate Fixation in Metacarpal Fractures. Orthopedics, 44, e91-e94. [Google Scholar] [CrossRef] [PubMed]
[6] Boonyasirikool, C. and Niempoog, S. (2014) Locked Intramedullary Nail: Metacarpal Geometry Study in Adults. The Journal of the Medical Association of Thailand, 97, S194-S198.
[7] Lixa, J., Vital, L., Vieira, P., Esteves, A., Silva, M., Pinho, A., et al. (2024) A Comparative Retrospective Study on Surgical versus Conservative Treatment of Simple Fifth Metacarpal Neck Fractures. Cureus, 16, e73439. [Google Scholar] [CrossRef] [PubMed]
[8] Luciani, M.A., Mayers, Y., Warnick, E.P., Udoeyo, I.F., Klena, J.C. and Grandizio, L.C. (2024) Trends in the Management of Fifth Metacarpal Neck Fractures. The Journal of Hand Surgery, 49, 384.e1-384.e9. [Google Scholar] [CrossRef] [PubMed]
[9] Warrender, W.J., Ruchelsman, D.E., Livesey, M.G., Mudgal, C.S. and Rivlin, M. (2019) Low Rate of Complications Following Intramedullary Headless Compression Screw Fixation of Metacarpal Fractures. Hand, 15, 798-804. [Google Scholar] [CrossRef] [PubMed]
[10] Avery, D.M., Klinge, S., Dyrna, F., Pauzenberger, L., Lam, D., Cote, M., et al. (2017) Headless Compression Screw versus Kirschner Wire Fixation for Metacarpal Neck Fractures: A Biomechanical Study. The Journal of Hand Surgery, 42, 392.e1-392.e6. [Google Scholar] [CrossRef] [PubMed]
[11] Ruchelsman, D.E., Puri, S., Feinberg-Zadek, N., Leibman, M.I. and Belsky, M.R. (2014) Clinical Outcomes of Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures. The Journal of Hand Surgery, 39, 2390-2395. [Google Scholar] [CrossRef] [PubMed]
[12] 杨蓊勃, 吴磊, 尹昭伟, 等. 闭合复位经第四掌骨平行克氏针内固定治疗第五掌骨颈骨折[J]. 中华手外科杂志, 2017, 33(5): 327-329.
[13] Hassan, K., Blumenthal, S., Jehle, C.C. and Sobel, A.D. (2024) Intramedullary Fixation of Hand Fractures and Arthrodeses. The Journal of Hand Surgery, 49, 42-49. [Google Scholar] [CrossRef] [PubMed]
[14] Supichyangur, K., Tananon, T., Sripakdee, S. and Chunyawongsak, V. (2023) Prospective Comparison of the Early Outcomes of Headless Compression Screw and Percutaneous K-Wire Fixation in Metacarpal Fractures. The Journal of Hand Surgery, 48, 950.e1-950.e9. [Google Scholar] [CrossRef] [PubMed]
[15] Assi, C., Mansour, J., Samaha, C., Ajjoub, S. and Yammine, K. (2019) A Single Antegrade Intramedullary K-Wire for Fifth Metacarpal Neck Fractures. European Journal of Trauma and Emergency Surgery, 46, 389-395. [Google Scholar] [CrossRef] [PubMed]
[16] Chen, K.J., Wang, J.P., Yin, C.Y., Huang, H.K., Chang, M.C. and Huang, Y.C. (2020) Fixation of Fifth Metacarpal Neck Fractures: A Comparison of Medial Locking Plates with Intramedullary K-Wires. Journal of Hand Surgery (European Volume), 45, 567-573. [Google Scholar] [CrossRef] [PubMed]
[17] Fan, X.L., Wang, J., Zhang, D.H., Mao, F., Liao, Y. and Xiao, R. (2021) Antegrade Intramedullary Fixation for Adolescent Fifth Metacarpal Neck Fracture and Its Impact on Epiphyseal Growth. BMC Musculoskeletal Disorders, 22, Article No. 546. [Google Scholar] [CrossRef] [PubMed]
[18] Kim, D., Lee, T., Na, Y. and Noh, Y. (2023) Comparative Evaluation of the Efficacy of Combined Intramedullary Pinning with K-Wires Pinning in the Treatment of Fifth Metacarpal Neck Fractures versus Conventional Techniques—K-Wires Pinning and Intramedullary Pinning. Medicina, 59, 1944. [Google Scholar] [CrossRef] [PubMed]
[19] Rivera-Saldívar, G., Rodríguez-Luna, C.E. and Orozco-Aponte, N.I. (2023) [Translated Article] Closed Reduction and Intramedullary Fixation of Fifth Metacarpal Neck Fractures: Retrograde vs. Anterograde Technique. Prospective Study. Revista Española de Cirugía Ortopédica y Traumatología, 67, T378-T386. [Google Scholar] [CrossRef] [PubMed]
[20] Poumellec, M.-A. and Dreant, N. (2017) Elastic Retrograde Intramedullary Percutaneous Pinning for Fifth Metacarpal Neck Fractures: A Series of 32 Patients. Hand Surgery and Rehabilitation, 36, 250-254. [Google Scholar] [CrossRef] [PubMed]
[21] Foucher, G., Chemorin, C. and Sibilly, A. (1976) A New Technic of Osteosynthesis in Fractures of the Distal 3D of the 5th Metacarpus. La Nouvelle Presse Medicale, 5, 1139-1140.
[22] Chiu, Y.C., Tsai, M.T., Hsu, C.E., Hsu, H.C., Huang, H.L. and Hsu, J.T. (2018) New Fixation Approach for Transverse Metacarpal Neck Fracture: A Biomechanical Study. Journal of Orthopaedic Surgery and Research, 13, Article No. 183. [Google Scholar] [CrossRef] [PubMed]
[23] Manueddu, C. and Della Santa, D. (1996) Fasciculated Intramedullary Pinning of Metacarpal Fractures. Journal of Hand Surgery, 21, 230-236. [Google Scholar] [CrossRef] [PubMed]
[24] 李海雷, 李大村, 赵亮, 等. 顺行克氏针髓内固定治疗第五掌骨颈骨折[J]. 中华手外科杂志, 2017, 33(2): 144-145.
[25] Boussakri, H., Elidrissi, M., Azarkane, M., Bensaad, S., Bachiri, M., Shimi, M., et al. (2014) Fractures of the Neck of the Fifth Metacarpal Bone, Treated by Percutaneous Intramedullary Nailing: Surgical Technique, Radiological and Clinical Results Study (28 Cases). Pan African Medical Journal, 18, Article No. 187. [Google Scholar] [CrossRef] [PubMed]
[26] Kaiser, M.M., Tafazzoli, K., Theilen, T., Schulz, A.P., Paech, A. and Wessel, L.M. (2009) Intramedullary Nailing for Metacarpal 2-5 Fractures. Journal of Pediatric Orthopaedics B, 18, 296-301. [Google Scholar] [CrossRef] [PubMed]
[27] Sadek, A.F. (2020) Flexible Stable Intramedullary Nailing for the Management of Metacarpal Neck Fractures. Journal of Hand and Microsurgery, 12, 189-196. [Google Scholar] [CrossRef] [PubMed]
[28] She, Y. and Xu, Y. (2017) Treatment of Fifth Metacarpal Neck Fractures with Antegrade Single Elastic Intramedullary Nailing. BMC Musculoskeletal Disorders, 18, Article No. 238. [Google Scholar] [CrossRef] [PubMed]
[29] Müller, M., Welle, K., Windemuth, M., Burger, C. and Pennekamp, P. (2013) Elastic Titanium Nails for Minimally Invasive Intramedullary Splinting of Metacarpal Fractures. Zeitschrift für Orthopädie und Unfallchirurgie, 151, 525-531. [Google Scholar] [CrossRef] [PubMed]
[30] Padegimas, E.M., Warrender, W.J., Jones, C.M. and Ilyas, A.M. (2016) Metacarpal Neck Fractures: A Review of Surgical Indications and Techniques. Archives of Trauma Research, 5, e32933. [Google Scholar] [CrossRef] [PubMed]
[31] 曾浪清, 曾路路, 陈云丰, 等. 顺行双弹性髓内钉与微型钢板内固定治疗第五掌骨骨折的疗效比较[J]. 中华手外科杂志, 2019, 35(1): 59-61.
[32] Zeng, L., Zeng, L., Miao, X., Chen, Y., Liang, W. and Jiang, Y. (2021) Single versus Dual Elastic Nails for Closed Reduction and Antegrade Intramedullary Nailing of Displaced Fifth Metacarpal Neck Fractures. Scientific Reports, 11, Article No. 1778. [Google Scholar] [CrossRef] [PubMed]
[33] 李晓阳, 杨胜武, 高伟阳, 等. AO微型钢板螺钉与克氏针治疗掌指骨骨折的比较研究[J]. 中华手外科杂志, 2004(1): 44-45.
[34] 高鹏, 吕立涛, 李华燕. 微型钢板与克氏针治疗闭合性掌骨骨折的临床疗效研究[J]. 中国医疗器械信息, 2025, 31(2): 66-68.
[35] 解琛, 李宗玉, 蔡锦方. 拳击手骨折的临床诊疗进展[J]. 实用手外科杂志, 2024, 38(3): 373-377.

为你推荐