Taha R, Davis T R, Montgomery A A, Karantana A
University of Nottingham, UK.
Nottingham University Hospitals NHS Trust, UK.
Ann R Coll Surg Engl. 2025 May;107(5):346-353. doi: 10.1308/rcsann.2024.0070. Epub 2024 Oct 8.
Metacarpal shaft fractures (MSF) are common injuries that predominantly affect young, economically active people. However, there is limited evidence to guide their management. The aims of this study were to: evaluate the management of extra-articular MSF of the fingers; assess equipoise for surgical and nonsurgical treatments; and explore factors influencing clinician decision making to inform the design of a randomised controlled trial (RCT) comparing surgical and nonsurgical treatments.
A cross-sectional, web-based survey was distributed to UK hand surgeons using membership directories of different professional networks. Practice setting, clinical experience, management strategies, willingness to participate in a RCT and factors affecting suitability for randomisation were recorded.
There were 108 responses eligible for analysis. Distribution of clinical experience ranged from <5 to >20 years. A variety of treatments were used for transverse, long oblique/spiral and comminuted MSF. Rotational deformity (90%), step-off deformity (5%) and angulation (5%) were the most important indications for surgical fixation. Acceptable limits of fracture angulation and shortening varied among surgeons. Over 85% expressed interest in participating in a RCT and most showed equipoise and were willing to offer operative or nonoperative treatment as part of a research study.
This survey demonstrates that UK hand surgeons have varying views on treatments, acceptable parameters of deformity and indications for surgical fixation of displaced MSF. There is equipoise for surgical and nonsurgical treatments, variability in factors influencing clinical decision making and support for RCTs to investigate best practice.
掌骨干骨折（MSF）是常见损伤，主要影响年轻且有经济活动能力的人群。然而，指导其治疗的证据有限。本研究的目的是：评估手指关节外掌骨干骨折的治疗情况；评估手术和非手术治疗的平衡状态；探索影响临床医生决策的因素，以为比较手术和非手术治疗的随机对照试验（RCT）设计提供信息。
通过不同专业网络的会员名录，向英国手部外科医生发放基于网络的横断面调查问卷。记录其执业环境、临床经验、治疗策略、参与RCT的意愿以及影响随机分组适用性的因素。
有108份回复符合分析要求。临床经验分布范围从<5年到>20年。对于横行、长斜形/螺旋形和粉碎性掌骨干骨折采用了多种治疗方法。旋转畸形（90%）、台阶样畸形（5%）和成角畸形（5%）是手术固定的最重要指征。不同外科医生对骨折成角和缩短的可接受限度各不相同。超过85%的人表示有兴趣参与RCT，大多数人表现出平衡状态，并愿意在研究中提供手术或非手术治疗。
本次调查表明，英国手部外科医生在治疗方法、畸形的可接受参数以及移位掌骨干骨折手术固定的指征方面存在不同观点。手术和非手术治疗存在平衡状态，影响临床决策的因素存在差异，且支持进行RCT以探究最佳治疗方法。
