RESUMO
BACKGROUND: Metacarpal fractures are common orthopedic injuries with potentially debilitating outcomes. Ideal surgical treatment remains a topic of debate, with intramedullary fixation becoming popular as a technique to allow for earlier mobilization with few reported complications. The aim of this study was to report observed outcomes and complications of intramedullary metacarpal fixation using the ExsoMed INnate metacarpal nail. METHODS: A retrospective chart review of 37 patients with 44 metacarpals treated with the ExsoMed INnate between July 2020 and December 2021 by a single fellowship-trained hand surgeon at a single level 1 trauma center was performed. Variables recorded included both patient and injury demographics, surgical complications, and postoperative outcomes. We also measured metacarpal isthmus diameter of the second to fifth metacarpals on all patients to determine the intramedullary canal diameter to assist in implant size selection. RESULTS: Average follow-up was 5.84 weeks with average time to radiographic healing of 5.5 weeks, and time to full activity 6.32 weeks. The mean postsurgical active total arc of motion was 250°, while passive total arc of motion was 259.74°. A total of 10 complications (22%) were identified, including 4 bent screws which occurred as a result of a punching event postoperatively. CONCLUSIONS: Intramedullary fixation of metacarpal fractures using the ExsoMed INnate metacarpal nail has shown to preserve range of motion and quick return to full activity, with a low rate of major complications. Our study highlights the potential major complication of the bent intramedullary screw and its association with an initial punching mechanism.
RESUMO
CONTEXT: The practice of osteopathic manipulative treatment (OMT) varies substantially across nations. Much of this variability may be attributed to disparate international educational, licensing, and regulatory environments that govern the practice of osteopathy by nonphysicians. This is in contrast with the United States, where osteopathic physicians are trained to integrate OMT as part of comprehensive patient management. OBJECTIVES: This study will analyze the factors associated with OMT use and its outcomes when integrated within the overall medical care for chronic low back pain (CLBP) provided by osteopathic physicians in the United States. METHODS: A retrospective cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through April 2022 to study the effectiveness of OMT integrated within medical care provided by osteopathic physicians. The outcome measures, which included pain intensity, pain impact, physical function, and health-related quality of life, were assessed with the National Institutes of Health Minimum Dataset, Patient-Reported Outcomes Measurement Information System, and Roland-Morris Disability Questionnaire. RESULTS: A total of 1,358 adults with CLBP entered the cohort (mean age, 53.2 years; 74.4% female), 913 completed the final quarterly encounter, 348 were in various stages of follow-up, and 97 had withdrawn. Blacks (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63; p<0.001), cigarette smokers (OR, 0.56; 95% CI, 0.33-0.93; p=0.02), and nonsteroidal anti-inflammatory drug users (OR, 0.59; 95% CI, 0.43-0.81; p=0.001) were less likely to have utilized OMT in the multivariable analysis. Mean between-group differences among 753 participants with no OMT crossover and complete follow-up favored OMT: 1.02 (95% CI, 0.63-1.42; p<0.001) for pain intensity; 5.12 (95% CI, 3.09-7.16; p<0.001) for pain impact; 3.59 (95% CI, 2.23-4.95; p<0.001) for physical function, and 2.73 (95% CI, 1.19-4.27; p<0.001) for health-related quality of life. Analyses involving propensity-score adjustment and inclusion of participants with missing data yielded similar conclusions. None of 12 prespecified participant characteristics demonstrated an OMT interaction effect. CONCLUSIONS: OMT integrated within medical care provided by osteopathic physicians for CLBP was associated with improved pain and related outcomes. Its use may be facilitated by the growing osteopathic physician workforce in the United States and adherence to relevant clinical practice guidelines.
