Adult patients with metacarpal fractures (MCFs) 2-4 and 5th MCFs (other than neck fractures), requiring nonoperative treatment. The fracture needs to be diagnosed on a radiograph at the emergency department.
Conditions
Interventions
INTERVENTION
Functional treatment of wrist and fingers by a Lucerne cast. Functional treatment will lead to less stiffness. The principle of the Lucerne cast is securing the MCP joints in flexion but
Sponsors
none
Eligibility
Inclusion criteria
Inclusion criteria: - Patients =18 years - Single MCF 2-4 (neck, shaft or intra-articular)and 5th MCFs (other than neck fractures) - Conservative treatment with a dynamic or forearm cast for four weeks.
Exclusion criteria
Exclusion criteria: - Operation indication; functional restrictions due to shortening, rotation or angulation - Volar angulation of the 5th ray = 30 - Volar angulation of the 4th ray =30 - Volar angulation of the 3th and 2nd ray =20 - Rotation disorders; clinical functional restriction such as scissoring fingers - Metacarpal shortening by segmental bone loss or < 50% bone to bone contact - Irreducible dislocations - Operative treatment - Fifth metacarpal neck fractures - Multiple metacarpal fractures in one hand - Metacarpal fracture of the first ray - Operative treatment - Absence of one of the following radiographs: Posterior-Anterior, 3/4-shot. - Patients with impaired hand function prior to injury due to arthrosis/neurological disorders of the upper limb - Multiple trauma patients (Injury Severity Score (ISS) =16) - Other injuries in the ipsilateral extremity - Insufficient comprehension of the Dutch language to understand a rehabilitation program and other treatment information as judged by the attending physician - Patient suffering from disorders of bone metabolism other than osteoporosis (i.e. Paget’s disease, renal osteodystrophy, osteomalacia) - Patients suffering from connective tissue disease or (joint) hyper-flexibility disorders such as Marfan’s, Ehler Danlos or other related disorders
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Function, pain and disability expressed as change in Michigan Hand Questionnaire Score (MHQ) during the first three months. MHQ will be assessed at baseline/randomization, one week, three weeks, five weeks and twelve weeks after randomization. The MHQ is a validated tool for assessing functional outcome in patients with complaints of the hand6,9. The MHQ is a questionnaire divided in six subscales; overall hand function, activities of daily living (ADLs), pain, work performance, aesthetics and patient satisfaction with hand function. Each subscale has a formula to calculate a score from 0 (severe disability) to 100 (no disability). The final score is a summation of the six individual item-scores divided by six and ranges from 0 (severe disability) to 100 (no disability). | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary: Pain, well-being, understanding medical information, total active motion of finger and wrist, patient satisfaction, patient expectation, quality of life, complications, work-absence, cost effectiveness. | — |
Contacts
Public ContactDorien Salentijn
OLVG/Maasstad ziekenhuis
Outcome results
None listed