Update 

This article was updated on January 18, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 103, in the first column of Table III, the continuous outcomes, which had been given as “Median” and “(range)”, are now given as “Mean” and “(95% CI)”, respectively.

Background: 

Finger metacarpal fractures represent up to 31% of all hand fractures, and most can be treated nonoperatively. Whether operative treatment is superior to nonoperative treatment for oblique and/or spiral finger metacarpal shaft fractures (MSFs) is unknown.

Methods: 

Forty-two patients with displaced oblique and/or spiral finger MSFs were randomized to either nonoperative treatment with unrestricted mobilization or operative treatment with screw fixation. The primary outcome was grip strength in the injured hand compared with the uninjured hand at the 1-year follow-up. Secondary outcomes were the Disabilities of the Arm, Shoulder and Hand score, range of motion, metacarpal shortening, complications, sick leave duration, patient satisfaction, and costs.

Results: 

All patients attended the 1-year follow-up. Mean grip strength relative to that in the contralateral hand was 104% (95% confidence interval [CI], 89% to 120%) in the nonoperative group and 96% (95% CI, 89% to 103%) in the operative group (p = 0.34). Mean metacarpal shortening was 5.3 mm (95% CI, 4.2 to 6.4 mm) in the nonoperative group and 2.3 mm (95% CI, 0.8 to 3.9 mm) in the operative group. In the nonoperative group, 1 minor complication was observed; in the operative group, there were 4 minor complications and 3 reoperations. The costs were estimated at 1,347 U.S. dollars (USD) for nonoperative treatment compared with 3,834 USD for operative treatment. Sick leave duration was significantly shorter in the nonoperative group (12 days [95% CI, 5 to 21 days] versus 35 days [95% CI, 20 to 54 days]) (p = 0.008).

Conclusions: 

When treated with unrestricted mobilization, patients with a single displaced spiral and/or oblique finger MSF have outcomes comparable to those treated operatively, despite metacarpal shortening. Costs are substantially higher (2.8 times) and sick leave is significantly higher in the operative group.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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手指掌骨干骨折移位的非手术治疗与手术治疗：一项前瞻性、非劣效性、随机对照试验

更新 

本文于 2023 年 1 月 18 日更新，因为之前的错误，该错误是在文章初稿发布到网上后发现的。在第 103 页，表 III 的第一列中，连续结果以前分别表示为“中位数”和“（范围）”，现在分别表示为“平均值”和“（95% CI）”。

背景： 

手指掌骨骨折占所有手部骨折的 31%，并且大多数可以非手术治疗。对于斜指和/或螺旋指掌骨干骨折（MSF），手术治疗是否优于非手术治疗尚不清楚。

方法： 

42 名斜指和/或螺旋指 MSF 移位的患者被随机分配接受无限制活动的非手术治疗或螺钉固定的手术治疗。主要结果是一年随访时受伤手与未受伤手的握力。次要结果是手臂、肩部和手部的残疾评分、运动范围、掌骨缩短、并发症、病假时间、患者满意度和费用。

结果： 

所有患者均参加了为期 1 年的随访。非手术组相对于对侧手的平均握力为 104%（95% 置信区间 [CI]，89% 至 120%），手术组为 96%（95% CI，89% 至 103%） （p = 0.34）。非手术组的平均掌骨缩短为 5.3 毫米（95% CI，4.2 至 6.4 毫米），手术组为 2.3 毫米（95% CI，0.8 至 3.9 毫米）。在非手术组中，观察到 1 例轻微并发症；手术组出现轻微并发症4例，再次手术3例。非手术治疗的费用估计为 1,347 美元 (USD)，而手术治疗的费用为 3,834 美元。非手术组的病假时间明显较短（12 天 [95% CI，5 至 21 天] 与 35 天 [95% CI，20 至 54 天]）（p = 0.008）。

结论： 

当采用不受限制的活动治疗时，尽管掌骨缩短，但单个螺旋状和/或斜指 MSF 移位的患者的结果与手术治疗的患者相当。手术组的费用要高得多（2.8 倍），病假也要高得多。

证据级别： 

治疗二级。有关证据级别的完整描述，请参阅作者须知。