The reverse oblique x-ray film: Metacarpal fractures revealed

Lane, Charles S.; Kennedy, Jane F.; Kuschner, Stuart H.

doi:10.1016/0363-5023(92)90362-s

Cited by 11 publications

(7 citation statements)

References 3 publications

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“…The fifth metacarpal neck is naturally angulated at 15°in the lateral plane, and the obliquity of the hand also alters the angulation on the radiograph. 23 Radiographic assessment of fifth metacarpal fractures has been shown to have some degree of interobserver and intraobserver variability in other studies. 24 To minimize this deficiency, 2 different techniques for measuring the fracture angulation were used.…”

Section: Discussionmentioning

confidence: 98%

Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study

Hofmeister

Kim

Shin

2008

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 98%

Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study

Hofmeister

Kim

Shin

2008

The Journal of Hand Surgery

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“…19 The necessity to precisely assess the degree of angulation of small finger metacarpal neck fractures has gained wide clinical acceptance by orthopaedic surgeons and radiologists and is considered to have important implications for both treatment options and outcomes. 1,3,5,8,20 In this regard, Leung and colleagues 5 reported a low level of the interobserver and intraobserver reliability of radiographic assessment of the small finger metacarpal neck fracture with two different methods of measurement. These authors conducted their study in a clinical setting, the observers representing a typical panel for decision making in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The standard oblique view, as described in radiographic positioning texts, was obtained by rotating the hand 458 laterally from the pronated, palm-down position. To facilitate the measurement of the metacarpal fracture angle, the images were relayed to a computer system used in current day-to-day clinical practice.…”

Section: Methodsmentioning

confidence: 99%

Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: Human cadaveric study

Mori

Sato

Hara

et al. 2005

Journal Orthopaedic Research

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To quantify reliability and validity of plain radiographs for assessing the degree of small finger metacarpal neck fracture angulation, we created typical two-fragments fractures in 30 adult cadaveric specimens. Reliability and validity of different radiographic measurement methods were determined by the intraclass correlation coefficient (ICC) and the Bland and Altman graphical approach. Intraobserver and interobserver reliability was high with any radiographic measurement method. Mean ICCs values (95% confidence intervals) varied from 0.76 (0.56-0.88) to 1.00 (0.99-1.00). The graphical approach confirmed good agreement. Validity was substantial when the fracture angle was measured between the line along the longitudinal axis of the metacarpal shaft and the line from the center of the metacarpal head to the fracture site on lateral radiographs. Mean ICCs values varied from 0.70 (0.36-0.86) to 0.79 (0.5-0.90). The graphical analysis also indicated good agreement. In contrast, considerable lack of validity was observed when the angle was measured on oblique radiographs. Although the mean ICCs values varied from 0.68 (0.12-0.88) to 0.74 (0.05-0.90), suggesting substantial correlation, the graphical analysis provided evidence for poor validity. There was systematic bias with oblique radiographs consistently producing higher readings (up to 358). In summary, reliability and validity are good only when the degree of small finger metacarpal neck fracture angulation is measured after drawing lines on lateral radiographs. Oblique radiograph measurements consistently produce higher readings. ß

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“…Clinical examination should be supplemented with appropriate radiological investigations. A minimum of PA and lateral views and if needed oblique views and special views like Brewerton's view[2] and skyline view[3] for fracture head of the metacarpal bone, 30° pronated and 30° supinated oblique view[4] for 2 nd and 5 th metacarpal shaft fracture is warranted. Stress views may be indicated in certain fracture dislocations .Sophisticated investigations like CT and MRI are rarely used in acute skeletal injuries of the hand.…”

Section: Introductionmentioning

confidence: 99%

Current concepts in managing fractures of metacarpal and phalangess

Kamath¹,

Harshvardhan²,

Naik³

et al. 2011

Indian J Plast Surg

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Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon's work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.

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The reverse oblique x-ray film: Metacarpal fractures revealed

Cited by 11 publications

References 3 publications

Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study

Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study

Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: Human cadaveric study

Current concepts in managing fractures of metacarpal and phalangess

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