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Does the Jahss Maneuver Maintain Reduction at First Follow-up?
Patrick Bryan Curtin, MD1, Matthew Defazio, MD1, Max Vaickus, MD1 and Marci Jones, MD2, (1)University of Massachusetts, Worcester, MA, (2)Department of Orthopedics, University of Massachusetts, Worcester, MA

Performing the Jahss maneuver on 5th metacarpal neck fracture and placing patients in an ulnar gutter splint is common practice at many institutions. We hypothesize that this maneuver does not always improve angulation and when it does, that most of these improvements are lost by the first follow-up appointment.

Material & Methods:
After IRB approval, patients with 5th metacarpal neck fractures were identified from a single tertiary care center over a 5-year period. Patient charts were reviewed for mechanism, treatment, and follow-up. Radiographs were reviewed on day of presentation both pre- and post-reduction with the Jahss maneuver, and at their first follow-up. Acceptable alignment was defined as 60 degrees or less of angulation with no clinical scissoring. Patients who did not undergo reduction with a Jahss maneuver and ulnar gutter splinting were excluded.

108 patients were identified with 5th metacarpal neck fractures and met inclusion criteria. 26 patients (24.1%) had endorsed or had radiographic proof of prior 5th metacarpal neck fractures from previous incidents.

At time of presentation, only 1 patient had a 5th metacarpal neck angle over 60 degrees. No patients had documented scissoring pre-reduction. Post-reduction, all patients had acceptable alignment. 67 patients (62.0%) had no change in their alignment in their post-reduction radiographs. The remaining 41 patients (38.0%) had improvement of their 5th metacarpal angle by at least 5 degrees, with an average improvement of 12.9 degrees.

At first follow-up, 3 patients (2.8%) had unacceptable alignment. Of the 41 patients who had improvement in their angulation after Jahss maneuver, 26 (63.4%) had loss of reduction. For these 26 patients with loss of reduction, all follow-up angulations were within 10 degrees of their pre-reduction angulation. Only 15 patients (7.2%) maintained their improved alignment at first follow-up, of which 100% were within acceptable angulation at time of presentation pre-reduction. For the 67 patients that had no improvement at time of presentation with the Jahss maneuver, follow-up angulation was equal to or improved from their initial injury films and did not progress/worsen.

The vast majority of patients in our cohort (99.1%) had acceptable angulation pre-reduction attempt. The Jahss maneuver improved angulation in only 38% of patients, of which the majority lost their improvement at first follow-up. Patients that did not improve their angulation with Jahss maneuver had relatively stable injuries, with angulation remaining almost identical in follow-up films compared to pre-reduction injury films.

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