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Revista Médica del Uruguay

versión impresa ISSN 0303-3295versión On-line ISSN 1688-0390


DELCASTILLO, Juan; CASALES, Nicolás  y  FILOMENO, Paola. Tratamiento de las fracturas no articulares de los metacarpianos excluido el primer dedo. Revisión bibliográfica sistematizada. Rev. Méd. Urug. [online]. 2016, vol.32, n.3, pp.205-217. ISSN 0303-3295.

Abstract Metacarpal fractures constitute 10% of the total number of fractures(1) and they represent 30%-50% of hand fractures(2). Fracture of the fifth metacarpal neck is the most frequent one, also called Boxer fracture, corresponding to 20% of all hand fractures. Literature favors a conservative treatment for most of these fractures, since they are stable from the beginning or after a closed reduction. Our bibliographic review aims to define the different criteria used to treat extra-articular metacarpal fractures excluding the thumb, with or without surgery. To that end, we conducted a systematized review of the last 10 years in patients over 18 years old, obtaining 19 articles that met our inclusion criteria. Our analysis strategy was to review therapy indications, frequency and justification. Systematized revision was divided into three groups of work: those who dealt with orthopedic treatment, those who indicated surgical treatment and those who compared results between the two treatments. Results led to the conclusion that there is no surgical indication that is universally recommended, since literature lacks Level I or II studies on this matter. Our review reveals the most frequently accepted surgical indications in literature. Dorsal angulation exceeding 30 degrees, malrotation and shortening stand out, all of which result in severe sequelae such as crossfinger, loss of extension or grip strength. Last, there being no consensus and until there is enough scientific evidence, decisions on therapeutic strategies are to the orthopedic surgeon, which decision shall be based on their experience, considering the kind of fracture, materials available and reviewed literature that supports it.


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