Boston Children's Hospital, MA, USA.
Hand (N Y). 2022 May;17(3):416-421. doi: 10.1177/1558944720942890. Epub 2020 Sep 17.
There is no clear consensus for the criteria for closed treatment of metacarpal neck fractures. Our objective was to determine whether closed reduction of pediatric fifth metacarpal neck fractures results in a clinically meaningful improvement in radiographic angulation.
We performed a retrospective cohort study of pediatric patients with fifth metacarpal neck fractures treated with closed reduction. Radiographs were examined for sagittal fracture angulation measured post-reduction, 2 to 14 days post-reduction, and 21 to 35 days post-reduction. We compared the angulation for open versus closed physes, initial fracture angulation greater than or less than 50°, and immobilization in extension versus intrinsic-plus position.
Fifty-four subjects were included with an average age of 14.8 years at the time of injury and a mean initial fracture angulation of 42.7°. The improvement in fracture angulation was 8.3° (90% confidence interval [CI], 5.9-10.7) on post-reduction radiographs, 8.5° (90% CI, 6.1-10.9) at 2 to 14 days post-reduction, and 4.3° (90% CI, 1.4-7.2) at 21 to 35 days post-reduction. Subgroup analysis showed that patients with injury angle greater than or equal to 50° had significantly higher mean reductions than those with injury angle less than 50°. In this group, angulation improved 15.6° (90% CI, 8.5-22.7) post-reduction, 15.1° (90% CI, 10.1-20.1) at 2 to 14 days post-reduction, and 16.5° (90% CI, 10.4-22.6) at 21 to 35 days post-reduction.
Closed reduction of pediatric fifth metacarpal neck fractures with initial fracture angulation less than 50° may not meaningfully improve sagittal alignment. For fractures with initial angulation greater than or equal to 50°, closed reduction resulted in clinically important, statistically significant, and lasting improvements of 16.5°.
对于掌骨颈骨折的闭合治疗标准尚无明确共识。我们的目的是确定闭合复位是否能使儿童第五掌骨颈骨折的影像学成角得到有临床意义的改善。
我们对接受闭合复位治疗的儿童第五掌骨颈骨折患者进行了回顾性队列研究。对复位后、复位后 2-14 天和复位后 21-35 天的矢状骨折角度进行了影像学检查。我们比较了骺板开放与闭合、初始骨折角度大于或小于 50°、以及伸直位与内在加位固定的差异。
54 例患者纳入研究，平均年龄为 14.8 岁，受伤时初始骨折角度平均为 42.7°。复位后骨折角度改善 8.3°（90%置信区间 [CI]，5.9-10.7），复位后 2-14 天改善 8.5°（90%CI，6.1-10.9），复位后 21-35 天改善 4.3°（90%CI，1.4-7.2）。亚组分析显示，初始骨折角度大于或等于 50°的患者比初始骨折角度小于 50°的患者平均复位幅度更大。在这个组中，复位后角度改善 15.6°（90%CI，8.5-22.7），复位后 2-14 天改善 15.1°（90%CI，10.1-20.1），复位后 21-35 天改善 16.5°（90%CI，10.4-22.6）。
对于初始骨折角度小于 50°的儿童第五掌骨颈骨折，闭合复位可能不会显著改善矢状面排列。对于初始角度大于或等于 50°的骨折，闭合复位可使 16.5°的骨折有临床意义、统计学意义和持久的改善。
