Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, FJD Health Research Institute, Madrid, Spain.
Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Diaz, FJD Health Research Institute, Madrid, Spain.
J Hand Surg Am. 2020 Dec;45(12):1134-1140. doi: 10.1016/j.jhsa.2020.05.013. Epub 2020 Jul 24.
Although fifth metacarpal neck fractures are typically treated nonsurgically, most often with closed reduction and orthosis immobilization, cast immobilization may not improve outcomes compared with buddy taping without reduction. The aim of this study was to compare functional outcomes of buddy taping versus reduction and cast immobilization in patients with fifth metacarpal neck fractures.
Adult patients with acute fifth metacarpal neck fractures with less than 70º volar angulation and without rotational deformity were randomly assigned to be treated either with buddy taping or a cast after closed reduction. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score at 9 weeks. Secondary outcomes included the DASH score at 3 weeks and 1 year, range of motion of the metacarpophalangeal joint, pain, grip strength, return to work, radiographic angulation, and complication rate.
We recruited 72 patients between August 2016 and January 2018. After 3 weeks, the DASH score was significantly lower for patients treated with buddy taping (19.7 ± 19.7) compared with cast immobilization (44.6 ± 15.0). At 9 weeks, clinical outcomes in the buddy taping group were better in terms of range of motion and DASH score, with a mean difference of 6.3 points, which did not exceed the minimally clinically important difference. There were more complications in the cast immobilization group. Fracture angulation after reduction was followed by a loss of reduction at 3 weeks' follow-up and equivalent residual radiographic volar angulation was observed at 3 and 9 weeks after injury in both groups. Duration of time off from work was 28 days shorter with buddy taping compared with cast treatment.
There is no benefit to reduction and orthosis immobilization of fifth metacarpal neck fractures with an initial angulation less than 70°. Use of buddy taping and early mobilization had good clinical results as well as significant improvement in time lost from work.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
尽管第五掌骨颈骨折通常采用非手术治疗，最常见的方法是闭合复位和矫形器固定，但与未复位的 buddy 带固定相比，石膏固定并不能改善结果。本研究的目的是比较 buddy 带固定与复位和石膏固定治疗第五掌骨颈骨折患者的功能结果。
将急性第五掌骨颈骨折且掌侧成角小于 70°且无旋转畸形的成年患者随机分为 buddy 带固定或闭合复位后石膏固定。主要结局为 9 周时的残疾上肢、肩和手（DASH）问卷评分。次要结局包括 3 周和 1 年时的 DASH 评分、掌指关节活动度、疼痛、握力、恢复工作、影像学成角和并发症发生率。
我们于 2016 年 8 月至 2018 年 1 月招募了 72 名患者。3 周后，与石膏固定组（44.6±15.0）相比，buddy 带固定组的 DASH 评分（19.7±19.7）显著更低。9 周时，buddy 带固定组在关节活动度和 DASH 评分方面的临床结果更好，平均差值为 6.3 分，未超过最小临床重要差异。石膏固定组的并发症更多。复位后骨折成角在 3 周随访时出现复位丢失，两组在受伤后 3 周和 9 周时观察到等效的残余掌侧成角。与石膏治疗相比，buddy 带固定组的停工时间缩短了 28 天。
初始成角小于 70°的第五掌骨颈骨折无需复位和矫形器固定。使用 buddy 带固定和早期活动可获得良好的临床结果，并显著缩短停工时间。
研究类型/证据水平：治疗性 I 级。
