Ambulante Behandlung der Mittelhand- und Fingerfrakturen führt zu gleichen Resultaten wie eine stationäre Behandlung

Zusammenfassung

Die operative Versorgung von Mittelhandknochen- und Fingerfrakturen kann sowohl ambulant als auch stationär durchgeführt werden. Das Ziel dieser Studie war es, die operativen Resultate von Mittelhandknochen- und Phalangenfrakturen nach ambulanter und stationärer Versorgung zu analysieren. In diese Studie wurden 85 Patienten mit einer Mittelhandknochen- oder Fingerfraktur, welche operativ in unserer Klinik behandelt wurden, eingeschlossen. Die Patienten wurden in 2 Gruppen unterteilt: stationäre Behandlung (> 24 Stunden) und ambulante Behandlung (< 24 Stunden). Ingesamt nahmen 53 Patienten nach einem durchschnittlichen Nachuntersuchungszeitraum von 17,9 Monaten (4–48 Monate, SD = 10 Monate) an der Nachuntersuchung teil. Bei allen Patienten wurden folgende Parameter untersucht: DASH-Score, Cooney-Score, Beweglichkeit als aktive Beweglichkeit in Relation zu der kontralateralen gesunden Seite und Komplikationen. Bei den Frakturen der Mittelhandknochen fanden sich keine signifikanten Unterschiede hinsichtlich des DASH-Scores (p = 0,18) und der Beweglichkeit (p = 0,12). Allerdings war der Cooney-Score bei den stationär behandelten Patienten mit 93,6 besser verglichen mit der ambulanten Gruppe (p = 0,01). Bei den Fingerfrakturen fanden sich sowohl für DASH- (p = 0,38) und Cooney-Score (p = 0,62) als auch für Beweglichkeit (p = 0,42) keine signifikanten Unterschiede für beide Gruppen. Insgesamt entwickelten 11 Patienten (20,7 %) eine Komplikation. Am häufigsten fand man postoperative Infektionen mit 6 Fällen (jeweils 3 in jeder Gruppe). Zusammenfassend führt eine ambulante Behandlung der Mittelhand- und Fingerfrakturen zu gleichen Resultaten wie eine stationäre Behandlung. Eine ambulante Behandlung von Mittelhand- und Fingerfrakturen sollte, wann auch immer möglich, in Betracht gezogen werden.

Abstract

Metacarpal and phalangeal fracture fixation may be conducted in ambulatory or inpatient settings. However, to date, little is known about the outcomes of the surgical treatment of metacarpal and phalangeal fractures in the two population groups. The aim of this study was to compare the surgical outcomes of patients undergoing treatment for metacarpal and phalangeal fractures in the ambulatory setting as compared to those in in-hospital settings. All patients who were surgically treated for metacarpal and phalangeal fractures at our institution were enrolled in this study. All patients treated non-surgically, as well as those who had sustained open fractures, were excluded from the study. A total of 85 patients met our inclusion criteria. Based on the length of hospital stay, patients were divided into two groups: inpatient (> 24 hours) and outpatient (< 24 hours). Fifty-three out of the eighty-five patients were available for follow-up examination. Patients were re-evaluated at a mean 17.9 months (range: 4–48 months; SD = 10 months) after surgery. Physical function in everyday life and specific hand function were compared between the groups using the DASH and Cooney outcome questionnaires. Range of motion of the affected side was measured using a standard goniometer and was evaluated as a proportion of total active motion (% TAM) relative to the contralateral uninjured side. Complication rates were calculated and compared between groups. There were no differences for the DASH outcome scores for phalangeal and metacarpal fractures on comparing both groups. There was also no statistically significant difference for the mean Cooney score for phalangeal fractures in both groups. The inpatient group had a significantly higher mean Cooney score (mean: 93.5; range, 70–100; SD 8.8; 95 % CI = 87.2, 99.8) after metacarpal fracture fixation than the outpatient group (mean: 82.5; range: 55–100; SD 14.5; 95 % CI = 75.3, 89.7) (p = 0.01). There was no statistically significant difference on comparing the mean proportion of total active motion (% TAM) relative to the contralateral uninjured side between the inpatient and outpatient groups (p > 0.05). The overall complication rate was 20.7 % (n = 11). The most common complication was postoperative infection with six cases (three inpatients; three outpatients). Outpatient surgical treatment of metacarpal and phalangeal fractures results in similar outcomes compared to inpatient treatment. Outpatient treatment of metacarpal and phalangeal fractures should be considered whenever possible.

Mittelhandknochenfraktur - Fingerfraktur - ambulant - stationär - DASH‐Score - Cooney‐Score

metacarpal fracture - phalangeal fracture - outpatients - inpatients - DASH score - Cooney score

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