Walde Melissa, Schaefer Dirk Johannes, Kaempfen Alexandre
Department of Plastic and Hand Surgery, University Hospital of Basel, 4031 Basel, Switzerland.
J Clin Med. 2024 Dec 14;13(24):7626. doi: 10.3390/jcm13247626.
: Most metacarpal fractures are isolated, simple, closed, and stable fractures and located distally. They are often caused by accidental falls, strikes by humans, by objects or traffic accidents. The majority can be treated conservatively. When unstable, angulated, malrotated or shortened, a surgical fixation of these frequent fractures is needed. To treat simple, spiral, distal or shaft fractures, intramedullary Kirschner wiring (KW) or intramedullary compression screws (ISs) are used. We wanted to compare the outcomes of those two treatments. : In a retrospective study we analyzed the prospectively collected data of our hospital on the indication factors and outcome factors of selected patients with simple or spiral, distal or shaft metacarpal fractures of the second to fifth finger. Indication factors were sex, age, profession, hand dominance, comorbidities, metacarpal finger number, total active range of motion (TAM), rotation, soft tissue damage, localization, articular involvement, fracture type, dislocation and axial shortening. Outcome factors were TAM, rotation, splint time, return to work, bone healing and complications. : Out of 750 patients, 59 fractures could be included in this study, containing 34 in the KW Group and 25 in the IS Group. Only fracture localization and fracture type were significantly different in the two groups, with more shaft and spiral fractures in the IS Group. The primary outcome of TAM and rotation as well as the secondary outcome of splint time, return to work, bone healing and complication rates showed no significant difference. Only a difference in mean follow-up time was seen. : Intramedullary screw fixation seems a valid alternative to KW fixation for certain fracture types regarding active range of motion and rotation after treatment, splint time, bone healing and return to work time. Only the tendency of an earlier return to work and a higher rate of full TAM after treatment was seen in favor of intramedullary screws.
大多数掌骨骨折为孤立性、单纯性、闭合性和稳定性骨折，且位于远端。它们通常由意外跌倒、人或物体撞击或交通事故引起。大多数此类骨折可采用保守治疗。当骨折不稳定、成角、旋转不良或缩短时，则需要对这些常见骨折进行手术固定。对于单纯性、螺旋形、远端或骨干骨折，可采用髓内克氏针（KW）或髓内加压螺钉（IS）进行治疗。我们希望比较这两种治疗方法的效果。
在一项回顾性研究中，我们分析了我院前瞻性收集的有关第二至五指单纯性或螺旋形、远端或骨干掌骨骨折患者的适应证因素和预后因素的数据。适应证因素包括性别、年龄、职业、用手习惯、合并症、掌骨手指序号、总主动活动度（TAM）、旋转、软组织损伤、骨折部位、关节受累情况、骨折类型、脱位和轴向缩短。预后因素包括TAM、旋转、夹板固定时间、恢复工作情况、骨折愈合及并发症。
在750例患者中，本研究纳入了59例骨折患者，其中KW组34例，IS组25例。两组仅在骨折部位和骨折类型上有显著差异，IS组骨干和螺旋形骨折较多。TAM和旋转的主要预后指标以及夹板固定时间、恢复工作情况、骨折愈合和并发症发生率的次要预后指标均无显著差异。仅在平均随访时间上存在差异。
对于某些骨折类型，在治疗后的主动活动度和旋转、夹板固定时间、骨折愈合及恢复工作时间方面，髓内螺钉固定似乎是KW固定的有效替代方法。仅观察到髓内螺钉在治疗后有更早恢复工作的趋势和更高的完全TAM率。
