Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
J Hand Surg Am. 2023 Sep;48(9):950.e1-950.e9. doi: 10.1016/j.jhsa.2022.02.010. Epub 2022 May 3.
The study aimed to assess early clinical outcomes achieved by headless compression screws (HCS) in fixation of metacarpal fractures, and to compare them with outcomes of percutaneous K-wire fixation. The hypothesis was that HCS would show better arc of motion and superior early clinical outcomes.
This was a randomized study of nonthumb metacarpal neck and shaft fractures. To compare the 2 surgical techniques, 23 patients treated for metacarpal neck and shaft fractures were divided into 2 groups: 11 treated with K-wire fixation and the other 12 with HCS fixation. We followed the patients for 12 weeks. The primary objective was to compare metacarpophalangeal arc of motion, and the secondary aim was to determine clinical union, radiographic union, and recovery time before returning to employment in the 2 groups.
At each follow-up visit, patients in the group treated with HCS had better metacarpophalangeal arc of motion than those treated with K-wire fixation. The HCS group showed a shorter time interval to return to work (at 3 weeks) and no complications, while the K-wire group had 1 pin track infection, which was treated with oral antibiotics and pin removal.
Compared with K-wire fixation, limited-open HCS fixation for metacarpal neck and shaft fractures was superior in terms of the early postoperative metacarpophalangeal arc of motion and return to work.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
本研究旨在评估无头加压螺钉（HCS）固定掌骨骨折的早期临床结果，并将其与经皮克氏针固定的结果进行比较。假设是 HCS 将显示更好的运动弧和更好的早期临床结果。
这是一项非拇指掌骨颈和骨干骨折的随机研究。为了比较这两种手术技术，将 23 例掌骨颈和骨干骨折患者分为两组：11 例采用克氏针固定，另 12 例采用 HCS 固定。我们对患者进行了 12 周的随访。主要目的是比较掌指关节的运动弧，次要目的是确定两组的临床愈合、影像学愈合和恢复工作前的时间。
在每次随访时，接受 HCS 治疗的患者的掌指关节运动弧均优于接受克氏针固定的患者。HCS 组的工作恢复时间更短（在 3 周时），且无并发症，而克氏针组有 1 例针道感染，经口服抗生素和针取出治疗。
与克氏针固定相比，微创 HCS 固定治疗掌骨颈和骨干骨折在术后早期掌指关节运动弧和恢复工作方面更具优势。
研究类型/证据水平：治疗性 II 级。
