Hayes Daniel S, Cush Coleman, El Koussaify Jad, Manzar Shahid, Klena Joel C, Grandizio Louis C
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
J Hand Surg Glob Online. 2023 Jun 1;5(5):677-681. doi: 10.1016/j.jhsg.2023.04.014. eCollection 2023 Sep.
Our purpose was to assess how nonunion of the metacarpals has been defined in prior investigations with respect to both clinical and radiographic criteria. We hypothesized that the definitions of nonunion would be highly variable.
A systematic review was conducted using MEDLINE and Embase databases for clinical articles related to the treatment of metacarpal fractures (surgical and nonsurgical) from 2010 to 2021. Included articles were searched to assess how nonunion was defined based on clinical and radiographic criteria. We assessed the treatment type, method of union assessment, time to union, and incidence of union as well as article factors such as the following: date of publication, level of evidence, and publishing journal.
A total of 641 articles were identified, of which 102 were included for a definition of nonunion and 97 were included for the assessment of clinical management and outcomes. Of the included articles, 62% contained level IV evidence. A definition of nonunion was provided in 47% of the articles. Radiographic criteria alone, clinical criteria alone, or a combination of the 2 was used in 22%, 6%, and 19% of the cases, respectively, to define nonunion. The most common definition of nonunion was presence of fracture-site tenderness (with no time defined) in 20 articles (20%), followed by lack of radiographic healing at 6 months (15%). In the 97 included articles, the total number of fracture cases was 4,435 and nonunion was reported in 0.45%. Cases with nonunion were reported in a total of six articles that used a variety of treatment modalities.
The definition of metacarpal nonunion remains highly variable and lacks standardization with respect to clinical and radiographic criteria.
Standardizing the definition of nonunion for metacarpal fractures would allow for more accurate assessments of the incidence of this complication and may aid in improving diagnostic and management strategies.
我们的目的是评估在先前的研究中，掌骨骨不连在临床和影像学标准方面是如何定义的。我们假设骨不连的定义会有很大差异。
使用MEDLINE和Embase数据库对2010年至2021年期间与掌骨骨折治疗（手术和非手术）相关的临床文章进行系统综述。对纳入的文章进行检索，以评估基于临床和影像学标准如何定义骨不连。我们评估了治疗类型、骨愈合评估方法、骨愈合时间、骨愈合发生率以及文章因素，如发表日期、证据水平和发表期刊。
共识别出641篇文章，其中102篇纳入了骨不连的定义，97篇纳入了临床管理和结果评估。在纳入的文章中，62%包含IV级证据。47%的文章提供了骨不连的定义。分别有22%、6%和19%的病例单独使用影像学标准、单独使用临床标准或两者结合来定义骨不连。最常见的骨不连定义是20篇文章（20%）中存在骨折部位压痛（未定义时间），其次是6个月时缺乏影像学愈合（15%）。在97篇纳入的文章中，骨折病例总数为4435例，骨不连报告发生率为0.45%。共有6篇文章报告了骨不连病例，这些文章使用了多种治疗方式。
掌骨骨不连的定义在临床和影像学标准方面仍然高度可变且缺乏标准化。
标准化掌骨骨折骨不连的定义将有助于更准确地评估这种并发症的发生率，并可能有助于改进诊断和管理策略。
