Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
J Hand Surg Am. 2024 Apr;49(4):384.e1-384.e9. doi: 10.1016/j.jhsa.2022.08.008. Epub 2022 Oct 7.
To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED).
We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only.
There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery.
Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
描述大型医疗保健系统中第五掌骨颈（5MCN）骨折的管理趋势。我们旨在确定与非手术与手术治疗相关的患者和外科医生因素，以及确定仅在急诊部（ED）接受治疗的相关因素。
我们在系统内确定了所有 5MCN 骨折病例，并记录了病例的基线人口统计学资料。记录了损伤、治疗和骨折特征。对于非手术治疗的骨折，我们确定了使用的固定类型（如果有），并记录了患者是否仅在 ED 就诊或接受了后续的门诊随访。对各组进行了人口统计学比较，并生成了调整后的逻辑回归模型，以预测接受手术治疗 5MCN 骨折或仅在 ED 就诊的可能性。
在 8 年的研究期间，共有 611 例 5MCN 骨折，其中 10%接受了手术治疗。在研究的前半段，8%的单纯性骨折接受了手术治疗，而在后半段则为 7%。软性敷料的使用越来越多。没有非手术治疗的病例因症状性愈合不良或畸形愈合而进行后续手术。21%的患者仅在 ED 就诊。骨折成角、伴发损伤、保险状况和手部外科医生治疗均与手术可能性增加显著相关。
在确定的 611 例 5MCN 骨折中，90%采用了非手术治疗。患者和外科医生因素与手术可能性增加相关。在寻求 5MCN 损伤治疗的患者中，超过 20%的患者在 ED 之外没有接受任何随访治疗。这些数据可用于评估未来管理趋势的变化，并表明愈合不良和症状性畸形愈合的情况并不常见。
研究类型/证据水平：预后 IV 级。
