van Aaken Jan, Kämpfen Stephan, Berli Martin, Fritschy Daniel, Della Santa Dominique, Fusetti Cesare
Unité de chirurgie de la main, Hôpital Universitaire de Genève (HUG), 24 rue Micheli-du-Crest, 1211, Geneva 14, Switzerland.
Hand (N Y). 2007 Dec;2(4):212-7. doi: 10.1007/s11552-007-9054-2. Epub 2007 Jul 3.
The ideal treatment for a boxer's fracture remains controversial, particularly the degree of volar dislocation considered acceptable for nonoperative treatment.
From December 2003 to December 2004, 25 patients who sustained a subcapital metacarpal fracture of the little finger with volar angulation between 30 to 75 degrees were prospectively enrolled in the study. All patients were treated with a circular self-adherent wrap covering metacarpal bones II-V and buddy taping of the ring and little fingers for a period of 3 weeks while allowing immediate free range of motion.
Final evaluation at a mean of 5 months revealed all patients to be satisfied without subjective functional impairment. All fractures healed, and the angulation of the fracture remained unchanged, but moderate shortening was observed. Active flexion of the metacarpophalangeal (MCP) joint was significantly lower on the fracture side, but as the median degree of MCP flexion was the same, this statistical difference was without clinical relevance. There was no loss in grip strength. A subjective long-term evaluation was performed by phone; at a median of 3 years, a QuickDash score gave a median of 0 point.
Treating a boxer's fracture with angulation of up to 75 degrees by soft wrap and buddy taping resulted in satisfied patients and good clinical results.
拳击手骨折的理想治疗方法仍存在争议,尤其是非手术治疗可接受的掌侧脱位程度。
2003年12月至2004年12月,前瞻性纳入25例小指近节指骨骨折且掌侧成角30至75度的患者。所有患者均采用环形自粘绷带包裹第2至5掌骨,并将环指和小指用胶带固定在一起,持续3周,同时允许立即进行自由活动。
平均5个月时的最终评估显示,所有患者均满意,无主观功能障碍。所有骨折均愈合,骨折成角未变,但观察到有中度短缩。骨折侧掌指关节(MCP)的主动屈曲明显较低,但由于MCP屈曲的中位度数相同,这种统计学差异无临床意义。握力无损失。通过电话进行了主观长期评估;中位3年时,QuickDash评分为中位数0分。
采用软绷带和胶带固定治疗成角达75度的拳击手骨折,患者满意度高,临床效果良好。