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Diagnosis and Treatment of 5Th Metacarpal Neck Fractures

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Diagnosis and Treatment of 5Th Metacarpal Neck Fractures , , , "#&&" '%'!"'# 1'!'%$ "%'(%& '&& "+!+ %% ''" /-.0 © Ida Neergård Sletten, 2014 Series of dissertations submitted to the Faculty of Medicine, University of Oslo No. 1867 ISBN 978-82-8264-920-9 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission. Cover: Hanne Baadsgaard Utigard. Printed in Norway: AIT Oslo AS. Produced in co-operation with Akademika Publishing. The thesis is produced by Akademika Publishing merely in connection with the thesis defence. Kindly direct all inquiries regarding the thesis to the copyright holder or the unit which grants the doctorate. =4<44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444A 1.1 Acknowledgements ........................................................................................................................ 5 1.2 List of papers ................................................................................................................................... 7 1.3 Table 1: Abbreviations .................................................................................................................... 8 1.4 Summary ........................................................................................................................................ 10 >4< 6 4444444444444444444444444444444444444444444444444444444444444444444444444444444444== 2.1 Anatomy ......................................................................................................................................... 11 2.2 Hand injuries and hand fractures ................................................................................................ 16 2.3 Fractures of the metacarpals ....................................................................................................... 20 2.4 5th metacarpal neck fracture (boxer’s fracture) .......................................................................... 21 2.5 Mechanism of injury and personality features in patients with 5th metacarpal neck fractures .............................................................................................................................................................. 23 2.6 Treatment options of 5th metacarpal neck fracture- including historical overview ................ 27 2.6.1 Conservative treatment ............................................................................................................ 27 2.6.2 Operative treatment .................................................................................................................. 29 2.6.3 Operative versus conservative treatment of 5th metacarpal neck fracture ............................... 32 2.7 Weaknesses in previous research .............................................................................................. 35 2.7.1 Definition of metacarpal neck area and metacarpal neck fractures ......................................... 35 2.7.2 Methods used for measuring volar angulation and shortening in metacarpal neck fractures .. 36 2.8.3 Other methodological weaknesses in previous clinical studies ................................................ 38 2.8 Patient ratings of hand function: The Quick-DASH Outcome Measure ................................... 39 2.9 Health economic aspects ............................................................................................................. 40 ?4< 44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444@> @4< 4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444@@ 3 4.1 Paper 1 ........................................................................................................................................... 44 4.3 Paper 2 ........................................................................................................................................... 44 4.4 Paper 3 ........................................................................................................................................... 46 4.2 Paper 4 ........................................................................................................................................... 47 4.5 Demographic parameters ............................................................................................................. 50 4.6 Clinical evaluation ......................................................................................................................... 50 4.7 Radiological evaluation ................................................................................................................ 51 4.8 Statistics ........................................................................................................................................ 54 4.9 Ethics ............................................................................................................................................. 57 A4< 444444444444444444444444444444444444444444444444444444444444444444444AD 5.1 Paper 1 ........................................................................................................................................... 58 5.2 Paper 2 ........................................................................................................................................... 58 5.3 Paper 3 ........................................................................................................................................... 58 5.4 Paper 4 ........................................................................................................................................... 59 B4< 8 2 944444444444444444444444444444444444444444444444444444444444444B< 6.1 Paper 1 ........................................................................................................................................... 60 6.2 Paper 2 ........................................................................................................................................... 61 6.3 Paper 3 ........................................................................................................................................... 64 6.4 Paper 4 ........................................................................................................................................... 67 C4< 44444444444444C? D4<444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444C@ E4< 8 7 27A9 7 4444444444444444444444444444444444444444444444444444444D? 4 Thanks to the Department of Orthopaedic surgery, Oslo University Hospital for supporting the research by giving me time and opportunity to perform the studies. Thanks to Sofies Mindes Ortopedi AS for supporting the research with two grants. I am greatly thankful for all help and advice from my three supervisors Lars Nordsletten, Hebe Desiree Kvernmo and Torstein Husby. A special thanks goes to Lars for being my main supervisor. His exceptional experience in orthopaedic research, constant support, patience and kind aid in all aspects of the work with the thesis have made the work exiting and manageable. Emergency department doctors Børge Olsen and Rune Ødegaard have co-supervised the inclusion and follow-up of patients in the randomised controlled study, and I am very grateful for your enthusiasm and interest in the project. Thanks to all doctors in the emergency department of Oslo University Hospital, and especially leaders Knut Melhuus and Martine Enger for help in inclusions of patients. Thanks to hand therapists Carina Rosales, Lise Bjørnstad and Lise Maurstad for examining all patients at follow-ups in Oslo University Hospital. Research assistant Eva Stednan has organized all follow-ups for patients in both clinical studies, and with the aid of Carina Rosales we managed a high follow-up rate in the randomised controlled study. The research project would not have been as successful without your eager help in locating the patients and continuously re-scheduling follow-up appointments. Radiologist and co-author Johan Castberg Hellund read all radiographs in both clinical studies as well as several thousand x-rays in the two radiological studies together with co-author Geir Hjorthaug and Anders Hammer. Thanks to statistician Ingar Holme for advice on the power analysis in the randomised controlled study, as well as being a co-author of the two radiological studies. Thanks to Ola-Lars Hammer and co-author Ståle Clementsen in Akershus University Hospital, and Morten Eikrem in Bærum hospital, Vestre Viken Hospital Trust, for the inclusion and follow-up of additional patients in the randomised controlled study. Many thanks to all colleagues and friends in Oslo University Hospital, Ullevål for valuable advice and help, especially to Ragnhild Øydna Støen, Frede Frihagen, Jan Erik Madsen and Gunnar Flugsrud. Thanks also to my present leader in Oslo University Hospital, Rikshospitalet, Magne Røkkum, for good advice and for allowing me extra time in preparation for the dissertation. Last but not least, I would like to thank my family and many friends for continuous moral support and encouragement. Without my parents’ practical help, I would never have been able to finish the thesis during maternity leave. I would also like to thank you for your constant love and care, and for always supporting me in further education.
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