Davison Peter G, Boudreau Nicole, Burrows Ruth, Wilson Kenneth L, Bezuhly Michael
Winnipeg, Manitoba, and Halifax, Nova Scotia, Canada From the Section of Plastic Surgery, Department of Surgery, University of Manitoba; the Department of Occupational Therapy and the Division of Plastic and Reconstructive Surgery, IWK Health Centre; and the Department of Surgery, Dalhousie University.
Plast Reconstr Surg. 2016 Mar;137(3):908-916. doi: 10.1097/01.prs.0000479974.45051.78.
Use of a hand-based thermoplastic splint for treatment of isolated fifth metacarpal neck fractures in pediatric patients has not previously been studied in a randomized blinded trial.
The authors conducted a blinded, 1:1 allocation, two-arm parallel group, superiority design, randomized controlled trial in patients aged 16 years or younger with isolated fifth metacarpal neck fractures. Patients were immobilized for 3 weeks in a conventional forearm-based ulnar gutter or hand-based thermoplastic splint. Primary outcome was difference in active range of motion between splint groups. Secondary outcomes included fracture union, treatment adherence, grip strength, and patient-reported pain and functional outcomes.
Between February of 2013 and August of 2014, 40 patients were enrolled in the trial. No differences were observed in baseline characteristics between groups. Mean range of motion was significantly better in the thermoplastic splint group compared with the ulnar gutter splint group at 3 weeks (p = 0.048). All patients had full range of motion at 12 weeks. Treatment adherence was 75 percent and 59 percent for ulnar gutter and thermoplastic splint groups, respectively (p = 0.46). Among ulnar gutter splint patients, decreased grip strength (injured versus noninjured) was observed at 3 and 6 weeks, and was significantly weaker compared with thermoplastic splint patients (p = 0.01). Reported pain scores were similar between groups. Patient-reported functional outcome scores were similar between groups at each time point. No nonunions were observed at 12 weeks.
In pediatric patients, hand-based thermoplastic splints resulted in improved early range of motion and grip strength, with no increased pain, nonadherence, or complications compared with conventional ulnar gutter splints.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
此前尚未在随机双盲试验中研究使用基于手部的热塑性夹板治疗小儿患者孤立的第五掌骨颈骨折。
作者对16岁及以下孤立的第五掌骨颈骨折患者进行了一项双盲、1:1分配、双臂平行组、优效性设计的随机对照试验。患者使用传统的基于前臂的尺侧沟夹板或基于手部的热塑性夹板固定3周。主要结局是夹板组之间主动活动范围的差异。次要结局包括骨折愈合、治疗依从性、握力以及患者报告的疼痛和功能结局。
在2013年2月至2014年8月期间，40例患者纳入试验。两组间基线特征无差异。与尺侧沟夹板组相比，热塑性夹板组在3周时平均活动范围明显更好（p = 0.048）。所有患者在12周时均有全范围活动。尺侧沟夹板组和热塑性夹板组的治疗依从性分别为75%和59%（p = 0.46）。在尺侧沟夹板组患者中，在3周和6周时观察到握力下降（受伤侧与未受伤侧相比），且与热塑性夹板组患者相比明显较弱（p = 0.01）。两组报告的疼痛评分相似。在每个时间点，两组患者报告的功能结局评分相似。在12周时未观察到骨不连。
在小儿患者中，与传统的尺侧沟夹板相比，基于手部的热塑性夹板可改善早期活动范围和握力，且疼痛、不依从或并发症均未增加。
临床问题/证据水平：治疗性，I级
