Paulus C, Suero E M, Schütz L, Josten C, Citak M
Klinik für Orthopädie und Unfallchirurgie, St. Elisabeth Saarlouis.
Z Orthop Unfall. 2011 Oct;149(5):550-3. doi: 10.1055/s-0031-1280120. Epub 2011 Oct 7.
Metacarpal and phalangeal fracture fixation may be conducted in ambulatory or inpatient settings. However, to date, little is known about the outcomes of the surgical treatment of metacarpal and phalangeal fractures in the two population groups. The aim of this study was to compare the surgical outcomes of patients undergoing treatment for metacarpal and phalangeal fractures in the ambulatory setting as compared to those in in-hospital settings. All patients who were surgically treated for metacarpal and phalangeal fractures at our institution were enrolled in this study. All patients treated non-surgically, as well as those who had sustained open fractures, were excluded from the study. A total of 85 patients met our inclusion criteria. Based on the length of hospital stay, patients were divided into two groups: inpatient (> 24 hours) and outpatient (< 24 hours). Fifty-three out of the eighty-five patients were available for follow-up examination. Patients were re-evaluated at a mean 17.9 months (range: 4-48 months; SD = 10 months) after surgery. Physical function in everyday life and specific hand function were compared between the groups using the DASH and Cooney outcome questionnaires. Range of motion of the affected side was measured using a standard goniometer and was evaluated as a proportion of total active motion (% TAM) relative to the contralateral uninjured side. Complication rates were calculated and compared between groups. There were no differences for the DASH outcome scores for phalangeal and metacarpal fractures on comparing both groups. There was also no statistically significant difference for the mean Cooney score for phalangeal fractures in both groups. The inpatient group had a significantly higher mean Cooney score (mean: 93.5; range, 70-100; SD 8.8; 95 % CI = 87.2, 99.8) after metacarpal fracture fixation than the outpatient group (mean: 82.5; range: 55-100; SD 14.5; 95 % CI = 75.3, 89.7) (p = 0.01). There was no statistically significant difference on comparing the mean proportion of total active motion (% TAM) relative to the contralateral uninjured side between the inpatient and outpatient groups (p > 0.05). The overall complication rate was 20.7 % (n = 11). The most common complication was postoperative infection with six cases (three inpatients; three outpatients). Outpatient surgical treatment of metacarpal and phalangeal fractures results in similar outcomes compared to inpatient treatment. Outpatient treatment of metacarpal and phalangeal fractures should be considered whenever possible.
掌骨和指骨骨折固定可在门诊或住院环境中进行。然而，迄今为止，对于这两类人群中掌骨和指骨骨折手术治疗的结果知之甚少。本研究的目的是比较在门诊环境中接受掌骨和指骨骨折治疗的患者与住院环境中患者的手术结果。在我们机构接受掌骨和指骨骨折手术治疗的所有患者均纳入本研究。所有接受非手术治疗的患者以及开放性骨折患者均被排除在研究之外。共有85例患者符合我们的纳入标准。根据住院时间长短，患者被分为两组：住院患者（>24小时）和门诊患者（<24小时）。85例患者中有53例可进行随访检查。患者在术后平均17.9个月（范围：4 - 48个月；标准差 = 10个月）时接受重新评估。使用DASH和Cooney结局问卷比较两组患者的日常生活身体功能和特定手部功能。使用标准测角仪测量患侧的活动范围，并将其评估为相对于对侧未受伤侧的总主动活动比例（%TAM）。计算并比较两组之间的并发症发生率。比较两组时，掌骨和指骨骨折的DASH结局评分没有差异。两组指骨骨折的平均Cooney评分也没有统计学上的显著差异。掌骨骨折固定后，住院组的平均Cooney评分（平均值：93.5；范围：70 - 100；标准差8.8；95%CI = 87.2, 99.8）显著高于门诊组（平均值：82.5；范围：55 - 100；标准差14.5；95%CI = 75.3, 89.7）（p = 0.01）。比较住院组和门诊组相对于对侧未受伤侧的总主动活动平均比例（%TAM）时，没有统计学上的显著差异（p>0.05）。总体并发症发生率为
