Biz Carlo, Iacobellis Claudio
Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padova, Italy.
Acta Biomed. 2014 Dec 17;85(3):252-64.
the management of the displaced extra-articular metacarpal fractures is still a subject of debate in the literature. The purposes of this study were to report the outcomes of unstable extra-articular metacarpal fractures treated by using intramedullary Kirschner wires or inter-fragmentary screws and to determinate which techniques provide better clinical and radiographic results.
we retrospectively reviewed a series of 49 consecutive patients operated for 53 closed, unstable metacarpal fractures. The fractures were divided into two groups, according to the fixation method used: the percutaneous intramedullary K-wire fixation group and the interfragmentary screw fixation group. The injuries were classified on the basis of fracture level and type. Assessment of patients was carried out according to the Mayo Wrist and Dash Scoring systems. Finally, radiographic and clinical outcomes of both groups were assessed and compared.
there were no significant differences between the two groups related to follow-up, hospitalization days, operating time, and Mayo Wrist and Dash Scores. Bone union was achieved within 6 weeks in all patients. Nine cases of malunion were found, with a mean angular deformity of 8.33° (range, 5°-15°), of which 8 were patients treated with K-wires (mean 8.125°) and 1 with screws (10°).
our results indicate that both procedures are effective in the treatment of displaced extra-articular metacarpal fractures. However, we believe K-wires represent the gold standard of treatment for displaced fractures of the metacarpal neck. Instead, screws are more effective for spiroid shaft fractures, while displaced fractures of the base may be treated with either screws or wires.
文献中对于移位的掌骨关节外骨折的处理仍存在争议。本研究的目的是报告采用髓内克氏针或骨折块间螺钉治疗不稳定掌骨关节外骨折的结果，并确定哪种技术能提供更好的临床和影像学效果。
我们回顾性分析了连续49例接受手术治疗的53例闭合性、不稳定掌骨骨折患者。根据固定方法，将骨折分为两组：经皮髓内克氏针固定组和骨折块间螺钉固定组。根据骨折部位和类型对损伤进行分类。根据梅奥腕关节评分系统和上肢功能评分系统对患者进行评估。最后，对两组的影像学和临床结果进行评估和比较。
两组在随访时间、住院天数、手术时间、梅奥腕关节评分和上肢功能评分方面无显著差异。所有患者均在6周内实现骨愈合。发现9例畸形愈合，平均成角畸形为8.33°（范围5°-15°），其中8例为接受克氏针治疗的患者（平均8.125°），1例为接受螺钉治疗的患者（10°）。
我们的结果表明，两种方法在治疗移位的掌骨关节外骨折方面均有效。然而，我们认为克氏针是掌骨颈移位骨折治疗的金标准。相反，螺钉对于掌骨干螺旋骨折更有效，而掌骨基底移位骨折可以用螺钉或克氏针治疗。
