University of Cincinnati College of Medicine, OH, USA.
Oregon Health & Science University, Portland, USA.
Hand (N Y). 2024 Oct;19(7):1084-1089. doi: 10.1177/15589447231170249. Epub 2023 May 24.
Metacarpal fractures are common and account for over 30% of all hand fractures. Previous literature has shown similar outcomes between operative and nonoperative management of metacarpal shaft fractures. There is little information regarding the natural history of conservatively managed metacarpal shaft fractures and changes in management based on follow-up radiographs.
A retrospective chart review was performed on all patients who presented to a single institution with an extraarticular metacarpal shaft or base fracture between 2015 and 2019.
Thirty-one patients with 37 metacarpal fractures were included for review: average age 41 years, male 48%, right hand dominant 91%, and average follow-up duration 7.3 weeks. At follow-up, a change of 2.4° in angulation ( = .0005) and a change in shortening of 0.1 mm ( = .0386) were noted over the 6-week time interval. No fractures had malrotation at presentation, and none developed malrotation during the follow-up period.
Recent systematic reviews and meta-analysis have suggested that metacarpal fractures treated nonoperatively had similar outcomes to surgical fixation at 12 months of follow-up. We found that extraarticular metacarpal shaft fractures that do not meet operative indications at the initial visit should be expected to heal reliably with minimal change in angulation and shortening over time. The transition to removable brace or no brace at the 2-week follow-up is likely sufficient, and additional follow-up is not necessary and will reduce cost.
Level III.
掌骨骨折很常见，占手部骨折的 30%以上。既往文献表明，掌骨干骨折的手术与非手术治疗结果相似。关于保守治疗的掌骨干骨折的自然病史以及基于随访 X 线片的治疗变化，相关信息较少。
对 2015 年至 2019 年间在一家机构就诊的 31 例掌骨骨干或基底部关节外骨折患者的病历进行回顾性分析。
37 例掌骨骨折患者纳入研究，平均年龄 41 岁，男性占 48%，右手优势 91%，平均随访时间为 7.3 周。随访时，在 6 周的时间间隔内，角度变化为 2.4°（ =.0005），缩短 0.1 毫米（ =.0386）。就诊时无骨折旋转移位，随访期间无骨折发生旋转移位。
最近的系统评价和荟萃分析表明，非手术治疗的掌骨骨折在 12 个月的随访中与手术固定的结果相似。我们发现，初始就诊时不符合手术指征的关节外掌骨干骨折，预计可可靠愈合，角度和缩短程度随时间变化最小。在 2 周随访时过渡到可移动支具或无支具可能就足够了，不需要进一步随访，这将降低成本。
III 级。
