Heckmann Nathanael, Dusch Marie N, Pannell William C, Bauschard Michael, Alluri Ram K, Sivasundaram Lakshmanan, Ghiassi Alidad
1 University of Southern California, Los Angeles, USA.
Hand (N Y). 2018 Nov;13(6):646-651. doi: 10.1177/1558944717733278. Epub 2017 Oct 5.
Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients.
Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded. Initial and postreduction radiographs were reviewed by 4 board-certified attending hand surgeons and 2 hand fellows who indicated their preferred management. At a later date, blinded to their initial management, the reviewers assessed follow-up films taken at least 2 weeks later and indicated their preferred management.
In total, 60 patients met inclusion criteria, and of those, 30 were randomly selected. There were 9 base, 7 shaft, and 14 neck fractures. Initially, reviewers opted for nonoperative management in 72.2% of base, 71.4% of shaft, and 91.7% of neck fractures. After reviewing follow-up films, reviewers changed from nonoperative to operative management in 0.0% of base, 9.5% of shaft, and 1.2% of neck fractures.
Follow-up radiographs may not be indicated for most fifth metacarpal base and neck fractures. Follow-up radiographs may change management in select fifth metacarpal shaft fractures as these fractures may displace. Follow-up radiographs should be performed at the discretion of the treating surgeon on an as-needed basis for fractures at risk for displacement.
第五掌骨骨折通常采用连续X线片进行非手术治疗；然而，这些X线片在改变临床治疗方案方面的作用尚未得到研究。我们假设随访平片不会改变临床治疗方案，因此对大多数患者来说是不必要的。
回顾性分析2007年至2014年期间在我们的一级创伤中心就诊的第五掌骨骨折患者。排除记录或影像学资料不完整、同侧上肢损伤或接受初始手术固定的患者。4名获得委员会认证的主治手外科医生和2名手外科住院医师对初始和复位后的X线片进行了评估，并表明了他们倾向的治疗方案。之后，在对他们的初始治疗方案不知情的情况下，评估人员对至少2周后拍摄的随访X线片进行了评估，并表明了他们倾向的治疗方案。
共有60例患者符合纳入标准，其中30例被随机选取。有9例基底骨折、7例骨干骨折和14例颈部骨折。最初，评估人员对72.2%的基底骨折、71.4%的骨干骨折和91.7%的颈部骨折选择非手术治疗。在查看随访X线片后，评估人员将基底骨折的非手术治疗改为手术治疗的比例为0.0%，骨干骨折为9.5%，颈部骨折为1.2%。
大多数第五掌骨基底和颈部骨折可能不需要随访X线片。随访X线片可能会改变部分第五掌骨干骨折的治疗方案，因为这些骨折可能会发生移位。对于有移位风险的骨折，应根据主刀医生的判断按需进行随访X线片检查。
