Kaynak Gokhan, Botanlioglu Huseyin, Caliskan Mustafa, Karaismailoglu Bedri, Ozsahin Mahmut Kursat, Kocak Soner, Yildirim Enis, Aydingoz Onder, Guven Mehmet Fatih
Department of Orthopaedics and Traumatology, Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Kocamustafapasa Cad. No: 53, Fatih, Istanbul, Turkey.
Department of Orthopaedics and Traumatology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
BMC Musculoskelet Disord. 2019 Apr 13;20(1):169. doi: 10.1186/s12891-019-2556-6.
Fifth metacarpal fractures are the most common fractures of the hand. These fractures are generally treated with conservative methods. The aim of this study was to compare the radiological and clinical outcomes of two conservative treatment methods, functional metacarpal splint(FMS) and ulnar gutter splint(UGS), for the treatment of fifth metacarpal neck fractures.
A prospective comparative study was designed to assess the conservative treatment of isolated and closed stable fractures of the fifth metacarpal neck. In total, 58 patients were included in the study and were treated with FMS or UGS after fracture reduction in a consecutive order. Angulation, shortening and functional outcome (QuickDASH scores and grip strengths) were evaluated at the 2nd and 6th months.
Forty patients returned for follow-up. Twenty-two patients were treated with FMS, and 18 patients were treated with UGS. The average age was 28 years (SD ± 12, range;18-43) in the FMS group and 30 years (SD ± 14, range;18-58) in the UGS group. After reduction, significant correction was achieved in both groups, but the average angulation was lower in the FMS group(16 ± 7) compared with the UGS group (21 ± 8)(p = 0.043). However, this better initial reduction in FMS group(16 ± 7) could not be maintained in the 1st month follow-up (21 ± 5) (p = 0.009). In the FMS group, the improvement in QuickDASH scores between the 2nd and 6th month follow-up was significant (p = 0.003) but not in the UGS group(p = 0.075). When the expected grip strengths were calculated, the FMS group reached the expected strength values at the 2nd month follow-up, whereas the UGS group still exhibited significantly lower grip strength at the 2nd month follow-up(p = 0.008). However, at the end of the 6th month follow-up, both groups exhibited similar reduction, QuickDASH and grip strength values.
In stable 5th metacarpal neck fractures, FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared with UGS. However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes. Patient comfort and compliance may be better with FMS due to less joint restriction, and these findings should be considered when deciding the treatment method.
ISRCTN79534571 The date of registration: 01/04/2019 Type of study/level of evidence: Therapeutic, II.
第五掌骨骨折是手部最常见的骨折。这些骨折一般采用保守方法治疗。本研究的目的是比较两种保守治疗方法，即功能性掌骨夹板（FMS）和尺侧沟夹板（UGS），用于治疗第五掌骨颈骨折的放射学和临床效果。
设计一项前瞻性比较研究，以评估第五掌骨颈孤立性闭合稳定骨折的保守治疗。总共58例患者纳入研究，骨折复位后依次采用FMS或UGS治疗。在第2个月和第6个月评估成角、缩短和功能结果（QuickDASH评分和握力）。
40例患者返回接受随访。22例患者采用FMS治疗，18例患者采用UGS治疗。FMS组平均年龄为28岁（标准差±12，范围18 - 43岁），UGS组平均年龄为30岁（标准差±14，范围18 - 58岁）。复位后，两组均实现了显著矫正，但FMS组平均成角（16±7）低于UGS组（21±8）（p = 0.043）。然而，FMS组较好的初始复位（16±7）在第1个月随访时未能维持（21±5）（p = 0.009）。在FMS组，第2个月和第6个月随访之间QuickDASH评分有显著改善（p = 0.003），但UGS组无显著改善（p = 0.075）。计算预期握力时，FMS组在第2个月随访时达到预期力量值，而UGS组在第2个月随访时握力仍显著较低（p = 0.008）。然而，在第6个月随访结束时，两组在复位、QuickDASH评分和握力值方面表现相似。
在稳定的第五掌骨颈骨折中，与UGS相比，FMS足以防止复位丢失，临床评分改善更快，握力恢复正常更早。然而，从长期来看，FMS和UGS方法产生相似的放射学和临床结果。由于关节限制较少，FMS可能使患者舒适度和依从性更好，在决定治疗方法时应考虑这些发现。
ISRCTN79534571 注册日期：2019年4月1日 研究类型/证据水平：治疗性，II级
