Abstract：
BACKGROUND: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand\'s functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways.
METHODS: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures.
RESULTS: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes.
CONCLUSIONS: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.
METHODS: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures.
RESULTS: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes.
CONCLUSIONS: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.
摘要：
背景：第五掌骨颈骨折（FMCNFs）在儿科患者中很常见。并发症包括减少掌指骨（MCP）的活动范围和握力，这阻碍了手的功能能力。提供各种管理选项，但是适应症没有标准化。本系统评价旨在吸收所有有关儿科FMCNFs管理的现有证据，以确定适当的治疗途径。
方法：PubMed(Medline)，EMBASE,Scopus和GoogleScholar被用来确定与这些骨折的管理有关的证据。
结果：确定了10项研究，涉及237名患者，平均年龄14.4岁（范围9-17）。90%的患者是男性。61名（26%）患者，平均断裂角度为27°（范围16°-33°），无旋转畸形，都是通过单独固定来管理的。这些患者恢复正常的掌指关节活动范围和握力。54名（23%）患者，平均断裂角度为42.7°(范围33°-54°),进行骨折复位和固定治疗。干预后，该技术无法持续减少骨折，并伴有明显的成角或旋转。一百二十二位(51%)病人,平均骨折角度为48.3°（范围30°-58°），包括旋转不良病例，进行骨折复位和手术固定。这些患者经历了良好的功能结果。
结论：本综述表明，当没有旋转畸形和角度<30°时，儿童FMCNFs可以单独固定治疗。在较高的骨折角度或旋转畸形的情况下，骨折复位和手术固定是一种合适的治疗方法。
方法：PubMed(Medline)，EMBASE,Scopus和GoogleScholar被用来确定与这些骨折的管理有关的证据。
结果：确定了10项研究，涉及237名患者，平均年龄14.4岁（范围9-17）。90%的患者是男性。61名（26%）患者，平均断裂角度为27°（范围16°-33°），无旋转畸形，都是通过单独固定来管理的。这些患者恢复正常的掌指关节活动范围和握力。54名（23%）患者，平均断裂角度为42.7°(范围33°-54°),进行骨折复位和固定治疗。干预后，该技术无法持续减少骨折，并伴有明显的成角或旋转。一百二十二位(51%)病人,平均骨折角度为48.3°（范围30°-58°），包括旋转不良病例，进行骨折复位和手术固定。这些患者经历了良好的功能结果。
结论：本综述表明，当没有旋转畸形和角度<30°时，儿童FMCNFs可以单独固定治疗。在较高的骨折角度或旋转畸形的情况下，骨折复位和手术固定是一种合适的治疗方法。
