University of Colorado School of Medicine, Aurora, CO, USA.
Denver Health Medical Center, Denver, CO, USA.
Hand (N Y). 2023 Jun;18(4):604-611. doi: 10.1177/15589447211063238. Epub 2022 Jan 7.
Reasonable functional outcomes for nonoperative management of isolated, closed fifth metacarpal neck fractures with up to 70° angulation have been reported; however, reported outcomes for fractures with greater than 70° angulation are limited. This study describes clinical outcomes of nonsurgically treated fifth metacarpal neck fractures with angulation of greater than 70°.
A retrospective review of patients treated between May 1, 2016, and May 1, 2020, included: (1) patients aged 18 years and above with an isolated, closed, fifth metacarpal neck fracture; (2) nonsurgical treatment; (3) healed fractures with angulation greater than 70° measured on oblique radiographs; and (4) minimum 6-month follow-up after injury. Photographic hand motion and patient-rated outcomes (Functional Hand Scale, Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], 12-item Short-Form Health Survey [SF-12]) were collected and reported.
A total of 364 fractures were identified; 11% (40/364) demonstrated angulation of greater than 70° (range: 71°-82°); and 15 patients (inclusion rate: 38%, 15/40) with mean fracture angulation of 73° (range: 71°-77°) participated in the study. Mean follow-up was 32 months (range: 8-120 months), the dominant hand was injured in 87% (13/15) of patients, and 47% (7/15) of patients worked in manual labor. All patients scored the highest rating of "very good" (range: 26-30 of 30 points) on the functional hand scale. A QuickDASH score of zero (no morbidity) was reported in 80% (12/15) of patients. About 87% (13/15) of patients had average or above-average scores on the SF-12 (mean = 109, range: 84-115).
Patients with healed, isolated, closed fifth metacarpal neck malunions with severe angulation greater than 70° demonstrated acceptable functional outcomes based on patient-rated outcomes scoring.
对于角度不超过 70°的非手术治疗的孤立、闭合第五掌骨颈骨折，已有合理的功能预后的相关报道；然而，对于角度大于 70°的骨折，其报道的结果有限。本研究描述了角度大于 70°的非手术治疗第五掌骨颈骨折的临床结果。
对 2016 年 5 月 1 日至 2020 年 5 月 1 日期间接受治疗的患者进行回顾性分析，包括：（1）年龄在 18 岁及以上的孤立性、闭合性、第五掌骨颈骨折患者；（2）非手术治疗；（3）愈合后角度大于 70°的斜位片测量；（4）受伤后至少 6 个月的随访。收集并报告手部运动的影像学图片和患者报告的结果（功能手量表、快速上肢肩肘手残疾量表[QuickDASH]、12 项简短健康调查量表[SF-12]）。
共确定 364 处骨折，其中 11%（40/364）显示角度大于 70°（范围：71°-82°）；15 名患者（纳入率：38%，40/105）平均骨折角度为 73°（范围：71°-77°）参与了研究。平均随访时间为 32 个月（范围：8-120 个月），其中 87%（13/15）的患者为优势手受伤，47%（7/15）的患者从事体力劳动。所有患者的功能手量表评分均为最高分“非常好”（30 分中的 26-30 分）。80%（12/15）的患者的 QuickDASH 评分为零（无残疾）。大约 87%（13/15）的患者的 SF-12 评分处于平均或高于平均水平（平均=109，范围：84-115）。
对于角度大于 70°的严重愈合性、孤立性、闭合性第五掌骨颈畸形愈合患者，根据患者报告的结果评分，其功能预后结果可接受。
