HAND & WRIST
Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):32 J Hand Surg Am. 2008 Oct;33(8):1362-881 patients from a naval medical center presenting with an acute isolated fracture of the fifth metacarpal neck were randomized to receive immobilization with either a short-arm cast with volar outriggers (SAC-VOR) with the metacarpophalangeal (MCP) joint in flexion, or immobilization with the MCP joint in extension using a cast with a 3-point mold about the fracture following closed reduction. The results indicated that both the MCP-flexion and MCP-extension casts were effective in maintaining fracture reduction, and no significant differences were observed between these two groups in terms of fracture healing, range of motion, grip strength and durability.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomização
3/4
Medidas de resultado
2/4
Inclusão/Exclusão
4/4
Descrição do tratamento
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Fifth metacarpal neck fracture is a common injury, resulting from a longitudinal compression force applied to a hand in a clenched fist position. These fractures typically present with an apex dorsal angulation, and although some degree of angulation can be tolerated in the sagittal plane, too much angulation can result in difficulties performing gripping motions. Typical treatment of this injury involves closed fracture reduction followed by immobilization with metacarpophalangeal (MCP) joint in flexion. However, another method of immobilization involves immobilization of MCP joint in extension with 3-point molded cast. Reported advantages of this method are its ease of application and IP joint freedom resulting in improved tolerability. A recent systematic review demonstrated that among non-operative treatments there was no superiority of one over another, therefore, indicating the need for this study.
主な研究課題は何ですか？
What is the effect of immobilization with MCP joint in flexion in a short-arm cast with volar outriggers (SAC-VOR) compared to a 3-point mold cast with MCP joint in extension, on the maintenance of reduction of closed isolated fifth metacarpal neck fractures, measured over 3 months?
重要な知見は？
- No differences between the groups existed when comparing demographic data (p>0.05).
- Application of the MCP-ext cast was significantly faster than the SAC-VOR cast (11 minutes vs. 15 minutes; p=0.025).
- An equal number of casts in each group needed replacement throughout the treatment period (7 in each group).
- DASH scores, range of motion, and grip strength were slightly improved in the MCT-ext group, but this superiority was not significant.
- There was no significant difference between the two groups in terms of immediate postreduction angulation in the lateral plane (p=0.453); however, there was a statistically significant improvement in postreduction angulation in the AP plane in the SAC-VOR group (14 deg vs. 5 deg; p<0.005).
- At 4 weeks, there was no significant difference in the maintenance of post-reduction alignment in either the lateral or AP plane, based on cast type or injury mechanism (AP plane, p=0.636, lateral plane, p=0.372).
- At 4 weeks, radiographic callus and healing was evident in all patients.
- Final MCP/PIP joint range of motion and grip strength was similar between the extension cast and MCP joint in flexion (SAC-VOR) groups (p>0.05 for all outcomes)
最も覚えておくべきことは？
Both immobilization with MCP joint in extension and the MCP joint in flexion were effective casting methods resulting in similar fracture healing rates, range of motion, grip strength and durability. Advantages of the MCT-ext cast were quicker application and increased tolerability.
それが私の患者ケアにどのように影響するか？
This study suggests that patients that have undergone closed reduction of fifth metacarpal fractures will achieve similar results with either a MCP-extension or MCP-flexion cast for immobilization. Further studies with larger sample sizes can further support the results.
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