Outcomes of four distinctive fixation methods in the conservative treatment of fifth metacarpal neck fractures

Kilic, Ayhan; Sökücü, Sinem Nedime; Basılgan, Seçkin; Yeniocak, Sedat; Çetinkaya, Engin; Parmaksizoglu, Atilla Sancar; Kabukçuoğlu, Yavuz

doi:10.5505/tjtes.2012.23090

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…2 Numerous studies have appraised different techniques of surgical and conservative treatments and showed similar outcomes in terms of recovery, range of motion (ROM) at the fifth MCPJ, grip strength and time to return to work. [4][5][6][7][8][9][10] Moreover, evidence suggests that patients who were treated with neighbour strapping and without regular follow up appointments had greater satisfaction, and no significant difference in functional outcome in relation to the other arm of the study that were treated in plaster and followed up. 11 The degree of acceptable fifth metacarpal head volar angulation remains under debate.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…3 There is a lack of consensus as to the optimum method of treatment with numerous studies comparing different operative and non-operative techniques with no demonstrable superiority of one method over another in terms of functional outcome. [4][5][6][7][8][9][10] Despite these variations, it is commonly treated non-operatively with good functional outcome and healing complications are rare. 2 Previously, in our institution, patients were diagnosed with fifth metacarpal neck fractures in the emergency department (ED) and were then referred to fracture clinic to be reviewed by the orthopaedics team.…”

Section: Introductionmentioning

confidence: 99%

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Closed fifth metacarpal neck fractures: Do they need to be seen in fracture clinic? An emergency department pathway for assessment, management and criteria for fracture clinic referral

Abdelmalek

Harrison

Scott

2014

Trauma

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Background: In our institution patients with fifth metacarpal neck fractures used to be referred to fracture clinic. The first audit aimed to assess if the referral changes management. This resulted in implementation of new practice, followed by the re-audit and follow up. Methods: We looked at 6 months data retrospectively, followed by prospective data collection for 6 months after initiation of new practice and electronic monitoring of re-referrals. Local systems were used for data extraction. Fracture assessment included angulation, rotational deformity and whether it was an open injury. The financial department assessed the cost of each fracture clinic. Results: Thirty-six patients included in the first audit compared to 27 in the re-audit, referral rate is 97% and 78%, respectively. All injuries were closed and there was no rotational deformity. Two patients had volar angulation more than 50 in the second sample but none in the first one. All patients were treated with neighbour strapping for one to two weeks and subsequent mobilisation. There were no instances of change of management with attendance at fracture clinic. Sixty percent got discharged in first appointment, compared to 50% after re-auditing. Re-referral rate is 0%. Each fracture clinic costs just over £700. Conclusions: Patients with fifth metacarpal neck fractures should be managed in the ED through an agreed pathway, unless they have rotational deformity, are open or angled beyond 50 in which case they should be referred to the fracture clinic or on call orthopaedic team as appropriate. This will not only avoid an unnecessary attendance at fracture clinic, but also provide cost saving.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Closed fifth metacarpal neck fractures: Do they need to be seen in fracture clinic? An emergency department pathway for assessment, management and criteria for fracture clinic referral

Abdelmalek

Harrison

Scott

2014

Trauma

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“…and were treated with FMS or UGS. The power analysis, based on previous reports [10], revealed that at least 14 subjects were needed in both groups for a power of 0.8 at a significance level of 0.05. The treatment plan was applied to patients in a consecutive manner based on referral time (quasi-randomisation).…”

Section: Methodsmentioning

confidence: 99%

Comparison of functional metacarpal splint and ulnar gutter splint in the treatment of fifth metacarpal neck fractures: a prospective comparative study

Kaynak

Botanlıoğlu

Çalışkan

et al. 2019

BMC Musculoskelet Disord

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Background Fifth metacarpal fractures are the most common fractures of the hand. These fractures are generally treated with conservative methods. The aim of this study was to compare the radiological and clinical outcomes of two conservative treatment methods, functional metacarpal splint(FMS) and ulnar gutter splint(UGS), for the treatment of fifth metacarpal neck fractures. Methods A prospective comparative study was designed to assess the conservative treatment of isolated and closed stable fractures of the fifth metacarpal neck. In total, 58 patients were included in the study and were treated with FMS or UGS after fracture reduction in a consecutive order. Angulation, shortening and functional outcome ( Quick DASH scores and grip strengths) were evaluated at the 2nd and 6th months. Results Forty patients returned for follow-up. Twenty-two patients were treated with FMS, and 18 patients were treated with UGS. The average age was 28 years (SD ± 12, range;18–43) in the FMS group and 30 years (SD ± 14, range;18–58) in the UGS group. After reduction, significant correction was achieved in both groups, but the average angulation was lower in the FMS group(16 ± 7) compared with the UGS group (21 ± 8)( p = 0.043). However, this better initial reduction in FMS group(16 ± 7) could not be maintained in the 1st month follow-up (21 ± 5) ( p = 0.009). In the FMS group, the improvement in Quick DASH scores between the 2nd and 6th month follow-up was significant ( p = 0.003) but not in the UGS group( p = 0.075). When the expected grip strengths were calculated, the FMS group reached the expected strength values at the 2nd month follow-up, whereas the UGS group still exhibited significantly lower grip strength at the 2nd month follow-up( p = 0.008). However, at the end of the 6th month follow-up, both groups exhibited similar reduction, Quick DASH and grip strength values. Conclusions In stable 5th metacarpal neck fractures, FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared with UGS. However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes. Patient comfort and compliance may be better with FMS due to less joint restriction, and these findings should be considered when deciding the treatment method. Trial registration ISRCTN79534571 The date of registration: 01/04/2019 Type of study/level of evidence: Therapeutic, II.

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A comparison of the functional and radiological results of Paris plaster cast and ulnar gutter splint in the conservative treatment of fractures of the fifth metacarpal

Gülabi

Avcı

Çeçen

et al. 2013

Eur J Orthop Surg Traumatol

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Outcomes of four distinctive fixation methods in the conservative treatment of fifth metacarpal neck fractures

Cited by 4 publications

References 15 publications

Closed fifth metacarpal neck fractures: Do they need to be seen in fracture clinic? An emergency department pathway for assessment, management and criteria for fracture clinic referral

Closed fifth metacarpal neck fractures: Do they need to be seen in fracture clinic? An emergency department pathway for assessment, management and criteria for fracture clinic referral

Comparison of functional metacarpal splint and ulnar gutter splint in the treatment of fifth metacarpal neck fractures: a prospective comparative study

A comparison of the functional and radiological results of Paris plaster cast and ulnar gutter splint in the conservative treatment of fractures of the fifth metacarpal

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