“…Der erste lag in der Verlagerung des Beobachterstandortes: weg vom Therapeuten und hin zum Patienten. Der zweite war die Priorisierung der Funktion vor abstrakten Messwerten oder gar Röntgenbildern [1,2]. Dabei halfen Studien, die mit allzu lange gepflegten Dogmen aufräumten.…”
Der Paradigmenwechsel in der Beurteilung medizinischer Behandlungsergebnisse
veranlasste Handchirurg Joachim Ganser und sein ergotherapeutisches Team zum
Umdenken hinsichtlich Frakturbehandlung der Hand. Viele Mittelhand- und
Fingerfrakturen lassen sich mit der richtigen Schienenversorgung konservativ
behandeln und bedürfen gar keiner Operation. Der Artikel stellt einige
davon exemplarisch vor.
“…Der erste lag in der Verlagerung des Beobachterstandortes: weg vom Therapeuten und hin zum Patienten. Der zweite war die Priorisierung der Funktion vor abstrakten Messwerten oder gar Röntgenbildern [1,2]. Dabei halfen Studien, die mit allzu lange gepflegten Dogmen aufräumten.…”
Der Paradigmenwechsel in der Beurteilung medizinischer Behandlungsergebnisse
veranlasste Handchirurg Joachim Ganser und sein ergotherapeutisches Team zum
Umdenken hinsichtlich Frakturbehandlung der Hand. Viele Mittelhand- und
Fingerfrakturen lassen sich mit der richtigen Schienenversorgung konservativ
behandeln und bedürfen gar keiner Operation. Der Artikel stellt einige
davon exemplarisch vor.
“…In 10% of the patients I still use antegrade pinning, based on patients’ request or unacceptable deformity other than palmar angulation, including rotational deformity (very rarely), displacement without contact between the fragments or concurrent displaced fracture of the metacarpal head. Only rarely I have encountered a patient treated non-operatively who needs secondary surgery and thus I have serious questions regarding the degree of angulation as a major indication for surgical treatment (Boeckstyns, 2020) and consider that this dogma should be revised or abandoned. Figure 2.Full flexion after healing of a boxer's fracture with optimal hand function.…”
Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.
“…Most surgeons agree that less than 40°–50° of dorsal apex angulation of the fifth metacarpal neck fracture does not need surgery, and from the small to index finger, the threshold of performing surgery decreases, from 40° to 30° to 20°. The author's experience indicates that even angulation at the fifth metacarpal neck exceeding 50° does not always need surgery (Boeckstyns, 2020). Absolute indications for internal fixation percutaneously or through an open approach are the unstable (single or multiple) fractures that cause functional loss of the hand and the displaced intra-articular fractures of the first CMC joint.…”
Section: Metacarpal Fracturesmentioning
confidence: 99%
“…Some fractured fingers can be mobilized immediately without fixation, including fractures of the base of the proximal phalanges, protected by buddy taping, and neck fifth metacarpal neck fractures, protected by a functional splint or even without splinting (Boeckstyns, 2020; Jardin et al., 2016; Vadstrup et al., 2014; van Aaken et al., 2016). Other non-operatively treated fractures must be protected for 2 to 3 weeks in a splint.…”
Section: Postoperative Motion and Therapymentioning
In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.
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