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.
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。