[Treatment of metacarpal fractures]. / Behandlungsmassnahmen bei Mittelhandfrakturen.

Conservative treatment of metacarpal fractures is recommended if there is no joint displacement, malrotation, displacement of over 30 degrees ad axim and shortening of over 5 mm. Surgery should be performed in open fractures and serial fractures of metacarpal bone. Early functional treatment should be carried out in stable, not displaced fractures. A cast can be used for a short period in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60 - 90 degrees. Twin-tape fixation allows functional treatment after soft-tissue swelling has disappeared. Closed reduction of displaced fractures of the fifth metacarpal bone (boxer's fracture) is not successful. Cases with displacement of over 30 degrees may be treated surgically by intramedullary stabilisation.

[Conservative treatment of metacarpal fracture]. / Die konservative Behandlung der Metacarpalfraktur.

Conservative treatment of meatacarpale fracture is recommended if there are no joint displacement, rotation failures, displacement over 30 degrees ad axim and shortening over 5 mm. Operative procedures should be done in open fractures and serial of fractures of metacarpale bones. Early functionally treatment should be done in stable, not displaced fractures. Cast can be used only for a short time in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60-90 degrees. Twin-tapes after reduction of edema allowed free range of motion by fixed rotation. Closed reduction of displaced fractures of fifth metacarpal bone (boxer's fracture) isn't successful. Cases with displacement over 30 degrees may be operatively treated by intramedullary stabilization.

[Treatment errors of metacarpal fractures. An analysis of expert testimony of the "Committee for Medical Malpractice" of the North Rhine Physician's Council]. / Behandlungsfehler bei Mittelhandfrakturen. Eine Analyse der Gutachten der "Kommission für ärztliche Behandlungsfehler" der Arztekammer Nordrhein.

A large number of publications notwithstanding, there are no clear guidelines regarding the treatment of metacarpal fractures. Some authors believe that even severely dislocated fractures should not be surgically fixated. This paper analyzes the forensic problem on the basis of court rulings in Germany. Seventeen evaluations of metacarpal fractures conducted by the commission on medical malpractice of the physicians' council in North Rhein were analyzed and common mistakes were listed. The average age of the eight male and nine female patients was 41.9 years. The fifth metacarpal bone (MB) was affected eight times, the fourth MB four times, and the first MB twice. The second MB and third MB were affected once each. Surgery was performed in nine cases, while the conservative approach was taken eight times. An independent expert determined medical malpractice in 13 cases (76%). In 10 of these 13 cases, the symptoms the patients exhibited were linked to medical malpractice. In the 13 cases of medical malpractice there were 5 cases with technically insufficient osteosynthesis, 4 cases of uncorrected dislocation, 2 false diagnoses, and 2 false immobilizations. An independent expert identified a link to the symptoms in three of the four cases of uncorrected dislocation. These were an anatomically nonreduced fracture with joint involvement, a fracture with a dislocation of 50 degrees, and a fracture with rotation dislocation. Cases where fractures healed with severe dislocation or immobilization in a wrong position or for a too long a period are common but avoidable mistakes in the treatment of metacarpal fractures.

[Are there guidelines for treatment of metacarpal fractures? Personal results and literature analysis of the last 12 years]. / Gibt es Richtlinien zur Behandlung von Mittelhandfrakturen? Eigene Ergebnisse und eine Literaturanalyse der letzten 12 Jahre.

As the treatment of metacarpal fractures is today still a controversial subject, we conducted an analysis of the literature in order to present the different therapy guidelines, indications, and their results. The data from the follow-up of 1602 patients was taken from literature which dated from 1 January 1984 to 31 March 1996. A total of 522 patients who underwent surgery received K-wires, screws or external minifixateur. The conservative approaches ranged from immobilization to various methods of mobilization with different aids or without fixation of the fracture. The mobilization in a brace provided good to excellent results in 95% of the cases; however, the failure rate of therapy was 23% because of local bruises and skin necrosis (3%). The mobilization with handcast, tape etc. attained good to excellent results in 94% of the cases. Here, no complications occurred. Both the immobilization treatment and the surgery provided good to excellent results in 85% of the cases. The reposition of fractures of the fifth metacarpal was successful in only 15% of the cases. Fractures with dislocations below 30 degrees, a shortening of less than 5 mm, no rotational displacement or that below 10 degrees, no articular incongruency, and no relevant soft tissue trauma do not need surgery according to our results and should be treated with early mobilization as suggested by the survey. Beyond these limits a primary surgical therapy is justified. The immobilization of metacarpal fractures over a period of more than 3-4 weeks is not necessary.