The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal.

The outcomes of 218 little finger metacarpal shaft and neck fractures that had been treated non-operatively, with no attempt at fracture reduction, were compared with those of 44 that had been treated operatively with fracture reduction and fixation (plates or K-wires). Outcome measures included the grip strength of the little finger and the DASH score. Fracture malunion was assessed by clinical measurement of little finger ray shortening and measurement of palmar angulation on the initial radiographs. The severity of palmar angular deformity did not affect the outcome of the 105 metacarpal neck or 113 metacarpal shaft fractures that had been treated non-operatively. There were no differences between the outcomes of the 18 metacarpal neck fractures treated operatively and the 105 treated non-operatively. The DASH score (P = 0.001) and aesthetic outcome (P = 0.013) were significantly better for the 113 metacarpal shaft fractures treated non-operatively than for the 26 treated operatively.

An evaluation of a clinical method to assess malunion of little finger metacarpal fractures.

This study assessed the reliability, responsiveness and validity of two clinical measurements for the assessment of malunion of little finger metacarpal neck and shaft fractures. Both compared the relative lengths of the ring and little fingers in the injured and contralateral hands. One measurement was taken with the metacarpophalangeal joints extended (straight-MCP), and the other with them flexed to 90 degrees (90-MCP). Ninety-five percent of the differences between the relative lengths of the ring and little fingers in the two hands of 50 normal subjects were less than 3mm and the 95% limits of agreement for repeat measurements (intra-observer reproducibility) was +/- 1 mm for both measurements. Both measurements were significantly altered in a group of 218 patients with a past history of a metacarpal shaft or neck fracture. Although both measurements correlated with the patient's assessment of the cosmetic result (p = 0.01), neither measurement correlated with the severity of palmar angulation of the fracture at presentation. It is concluded that these measurements are reliable and responsive, but their validity is uncertain.

The rapid exchange grip strength test and the detection of submaximal grip effort.

This study assessed the reliability of the rapid exchange grip test for detecting submaximal grip effort, particularly evaluating its performance with motivated subjects with genuine hand weakness secondary to pain. Fifty normal participants performing with maximum effort then feigning hand weakness and 50 patients recovering from carpal tunnel surgery were studied. The results showed that the dynamic measure of grip strength equaled or exceeded the static measure in 28% of maximally performing participants (72% specificity), 58% of the carpal tunnel decompression patients (42% specificity), and 74% of participants giving submaximal grip effort (74% sensitivity). Sensitivities and specificities for other criteria of a positive test were also determined. Our findings suggest that the rapid exchange grip strength test cannot reliably detect voluntary submaximal effort.

Ganglia: the patient's perception.

This study investigates the concerns of 50 patients with ganglia and their reasons for primary care consultation and referral to a hand unit. Although a minority of patients sought advice and treatment because of pain, more (38%) were concerned about the cosmetic appearance and a significant number (28%) were concerned that their ganglion was a malignant growth. The general practitioners referred 70% of patients to the hand clinic for "excision of the ganglion" and 30% for further "advice and treatment". However, 74% of patients were satisfied with aspiration of the ganglion and general advice.