Health Sciences University, Umraniye Training and Research Hospital, Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Health Sciences University, Umraniye Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul Turkey.
J Orthop Sci. 2024 Sep;29(5):1196-1202. doi: 10.1016/j.jos.2023.08.004. Epub 2023 Aug 12.
This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS).
The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS.
Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p < 0.001). ROM of the interphalangeal and metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p < 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p < 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p < 0.05), as determined by the EQ-5D-5L.
Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.
本研究比较了短臂石膏夹板（SAPS）与动力掌骨稳定夹板（DMSS）治疗第五掌骨颈骨折的临床和影像学结果。
119 例患者于 2018 年至 2019 年期间在我院就诊，经适当的初始闭合复位后，分别采用 SAPS 或 DMSS 治疗。治疗后第 10 天和第 20 天，以及治疗后 1、2 和 3 个月进行随访检查。每次就诊时评估骨折对线、关节活动度（ROM）和并发症。使用测力计评估握力。使用 EuroQol 5 维度 5 级（EQ-5D-5L）和视觉模拟评分（VAS）评估自理能力、日常活动、疼痛/不适和焦虑/抑郁。
119 例患者中，103 例完成了所有随访检查。共 51 例患者采用 SAPS 治疗，52 例患者采用 DMSS 治疗。DMSS 组中有 5 例患者出现皮肤损伤，但 SAPS 组中没有（p=0.008）。DMSS 组患者的握力在 1、2 个月和 3 个月随访时明显更好（p<0.001）。DMSS 组患者在 1 个月随访时指间和掌指关节的 ROM 明显更好（p<0.001），但在 3 个月随访时相似（p=0.27）。DMSS 组在 3 个月随访时腕关节 ROM 明显更高（p<0.05）。DMSS 组在所有随访时间的自理能力、日常活动、疼痛/不适和焦虑/抑郁方面均明显优于 SAPS 组（p<0.05），由 EQ-5D-5L 确定。
DMSS 对稳定的拳击手骨折进行动态稳定与 SAPS 对维持复位和保证愈合同样有效。然而，DMSS 提供了更好的早期 ROM、舒适度和肌肉力量，以及更早地恢复日常活动，尽管偶尔会出现皮肤损伤。
