DeBiasio Celina, Sucha Ewa, Webster Richard J, Tse Sandy, Cheung Kevin
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Plast Surg (Oakv). 2024 Mar 6:22925503241234938. doi: 10.1177/22925503241234938.
Fractures of the fifth metacarpal are a common injury. In children, they are often stable and heal uneventfully, including after closed reduction. Fractures of the metacarpal diaphysis, conversely, tend to be unstable and may require surgical intervention. It is unclear at what point fractures of the fifth metacarpal fracture should be considered unstable. We identify the location at which a fifth metacarpal fracture is at risk for surgical intervention. A two-year retrospective cohort analysis of all children (age ≤18) with fifth metacarpal fractures presenting to a Pediatric Plastic Surgery clinic was performed. Clinical and radiographical data were acquired from electronic medical records. Fracture location and fracture angulation were measured, descriptive statistics were performed, and multivariable logistic regression was used to identify predictors for surgery. Ninety-eight patients met criteria for review. Mean patient age was 14.0 years (SD 2.2), and 95% were male. Forty-two (44.2%) patients underwent closed reduction, and 12 (12.2%) patients were recommended for surgery. Increased fracture angulation on initial lateral radiograph (OR: 1.08 (1.03-1.14 95% CI), p = 0.006) and more proximal fractures (OR: 0.92 (0.86-0.98 95% CI), p = 0.008) were identified as independent predictors for surgery. Fractures occurring proximal to 70% of metacarpal length resulted in accurate detection of those requiring surgery with 72.4% sensitivity, 75.3% specificity, 95.5% and 27.6% negative and positive predictive value, respectively. In pediatric fifth metacarpal fractures, increased fracture angulation and those occurring proximal to 70% of the metacarpal length were independent predictors for surgery.
第五掌骨骨折是一种常见的损伤。在儿童中，此类骨折通常较为稳定，愈合顺利，即使在闭合复位后也是如此。相反，掌骨干骨折往往不稳定，可能需要手术干预。目前尚不清楚第五掌骨骨折在何种情况下应被视为不稳定。我们确定了第五掌骨骨折有手术干预风险的位置。对所有就诊于小儿整形外科诊所的第五掌骨骨折儿童（年龄≤18岁）进行了为期两年的回顾性队列分析。从电子病历中获取临床和影像学数据。测量骨折位置和骨折成角，进行描述性统计，并使用多变量逻辑回归来确定手术的预测因素。98例患者符合纳入标准。患者平均年龄为14.0岁（标准差2.2），95%为男性。42例（44.2%）患者接受了闭合复位，12例（12.2%）患者被建议进行手术。初始侧位X线片上骨折成角增加（比值比：1.08（1.03 - 1.14，95%置信区间），p = 0.006）和骨折位置更靠近近端（比值比：0.92（0.86 - 0.98，95%置信区间），p = 0.008）被确定为手术的独立预测因素。发生在掌骨长度70%近端的骨折，对需要手术的患者检测准确率分别为：敏感度72.4%、特异度75.3%、阴性预测值95.5%、阳性预测值27.6%。在小儿第五掌骨骨折中，骨折成角增加以及发生在掌骨长度70%近端的骨折是手术的独立预测因素。
