Both MCP-flexion and MCP-extension casts are effective immobilization methods .
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
- 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)
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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