Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients.

Current literature gives few guidelines regarding indication for operative treatment of little finger metacarpal neck fractures, and some surgeons choose operative treatment when the palmar angulation exceeds 30°. The objective of this study was to determine whether conservative treatment produces comparable outcomes with bouquet pinning in a randomized, controlled trial. Eighty-five patients with little finger metacarpal neck fractures with ≥30° palmar angulation in the lateral view were included. Patients were randomized to two groups: conservative treatment without reduction of the fracture (43 patients); and closed reduction and bouquet pinning (42 patients). After 1 year, there were no statistical differences between the groups in QuickDASH score, pain, satisfaction, finger range of motion, grip strength, or quality of life. There was a trend versus better satisfaction with hand appearance (p = 0.06), but longer sick leave (p < 0.001) and more complications (p = 0.02) in the operative group.

Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study.

Four methods for measuring volar angulation in 5th metacarpal neck fractures were tested for validity and reliability. Mid-medullary canal measurement in the lateral view (method MC-90) has previously been proven valid in a cadaveric study, hence used as a reference to test validity of the latter three. These three yielded a significant different mean fracture angle compared with MC-90, with only minor enhancement in reliability. Therefore, none of these three methods is recommended as a better standard method than the MC-90, where reliability was found to be substantial (intraclass correlation coefficient 0.53-0.81). Two methods for measuring shortening in 5th metacarpal neck fractures were compared, and stipulation of shortening by drawing a line through the most distal point of the heads of the neighbouring 3rd and 4th metacarpals (method SH-Stip) is a simple method with excellent reliability (intraclass correlation coefficient 0.81-0.96) for estimating shortening, requiring only radiological examination of the injured hand.

Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients.

Although extra-articular metacarpal fractures are common, there is no consensus on the mode of treatment. We evaluated the outcome in 67 patients operated for isolated, extra-articular fractures in the neck or shaft of the ulnar two metacarpals 28 months post-operatively. There were 22 bouquet (intra-medullary) pinnings and 45 transverse pinnings; 11 were lost to follow-up. Overall, hand function was good, and no difference was detected between the two methods (QuickDASH, grip strength, range of motion, VAS pain and VAS satisfaction). Many patients suffered complications: 12% had a superficial infection (all treated with transverse pinning with wires left exposed); 39% had some impairment in skin sensation; 29% reported cold intolerance; and 10% had other complications. Due to the potential risk of a secondary fracture of the neighbouring metacarpal after transverse pinning, we recommend bouquet (intra-medullary) pinning. We also recommend burying wires beneath the skin surface to avoid infection.

Cellular activation in response to physical exercise: the effect of platelets and granulocytes on monocyte reactivity.

After physical exercise monocytes have been shown to express more lipopolysaccharide (LPS)-induced tissue factor activity compared with monocytes at rest. This is in contrast to LPS-induced tumor necrosis factor (TNF)-alpha production, which is reduced after physical exercise. Furthermore, LPS-induced tissue factor activity in monocytes at rest has been shown to be dependent on platelets and granulocytes, whereas LPS-induced TNF-alpha is not affected by these cells. The aim of the present study was to test how platelets and granulocytes affect LPS-induced tissue factor activity in monocytes observed after exercise. This was done by separating the different blood cells before and after exercise, followed by recombination of the cells in plasma and quantification of LPS-induced tissue factor activity in vitro. Two groups of subjects with different aerobic endurance levels were tested to reveal possible differences as a result of physical conditioning. The results of the present study showed that the major effect of exercise was associated with a change in the reactivity of monocytes themselves, since monocytes from blood samples taken after running recombined with platelets, and granulocytes showed the greatest increase in tissue factor activity. Platelets and granulocytes stressed by physical exercise had no further enhancing effect on LPS-induced tissue factor activity other than that observed at rest. The lowest LPS-induced tissue factor activity in all combinations of blood cells was found in athletes, compared with less trained subjects, both at rest and in response to exercise.