Zhang Min, Hirth Melissa, Cole Tanya, Hew John, Lim Pelicia, Ng Sally
Plastic and Reconstructive Surgery Department, Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia.
Occupational Therapy Department, Austin Health, 145 Studley Rd, Heidelberg, VIC 3084, Australia.
JPRAS Open. 2024 May 9;41:37-51. doi: 10.1016/j.jpra.2024.05.002. eCollection 2024 Sep.
Systematic review.
Proximal phalangeal fractures of the hand are challenging to treat, and significantly impact hand function and quality of life if poorly managed.
A systematic review to determine the efficacy of conservatively managed extra-articular proximal phalanx fractures to optimise recovery and prevent the need for surgical intervention and its associated risks.
A literature search that included variations of the phrases 'proximal phalanx', 'fracture' and 'conservative management' was performed on 17 December 2023 using seven electronic databases and trial registries. Article screening, data extraction and critical appraisal using the Structured Effectiveness Quality Evaluation scale was performed independently.
Seven studies that captured 389 fractures from 356 unique patients were included. Studies were of level II to IV evidence and included one comparative cohort study and six prospective case series. Interventions involved timely rehabilitation, a plaster or orthotic device, controlled metacarpophalangeal joint flexion and free mobilisation of the interphalangeal joints. A weighted mean total active motion score of 249° was achieved, with 99.5% (387/389) of fractures achieving union.
This systematic review cautions against definitive recommendations on conservative techniques for managing proximal phalanx fractures due to limitations of the available literature. However, our findings tentatively supports non-operative approaches as an alternative to surgery.
系统评价。
手部近节指骨骨折的治疗具有挑战性，如果处理不当会严重影响手部功能和生活质量。
进行一项系统评价，以确定保守治疗关节外近节指骨骨折的疗效，从而优化恢复情况并避免手术干预及其相关风险。
于2023年12月17日使用七个电子数据库和试验注册库，对手语“近节指骨”、“骨折”和“保守治疗”的变体进行文献检索。独立进行文章筛选、数据提取，并使用结构化有效性质量评估量表进行批判性评价。
纳入七项研究，共涉及356例独特患者的389处骨折。研究证据等级为II至IV级，包括一项比较队列研究和六项前瞻性病例系列研究。干预措施包括及时康复、使用石膏或矫形器、控制掌指关节屈曲以及指间关节自由活动。加权平均总主动活动度评分为249°，99.5%（387/389）的骨折实现愈合。
由于现有文献存在局限性，本系统评价对关于近节指骨骨折保守治疗技术的确切建议持谨慎态度。然而，我们的研究结果初步支持非手术方法可作为手术的替代方案。
