This Ph.D. project deals with extra-articular fractures of the metacarpals of the hand, in particular fractures of the neck of the 5th metacarpal (“boxer’s fracture”), the most common fracture site distal to the radiocarpal joint. Four papers are included in the thesis, based on two clinical studies on patients who were treated for metacarpal fractures in our department (Department of orthopaedic surgery, Oslo University Hospital, Ullevål, Oslo, Norway). The first clinical study was a retrospective comparison of two cohorts of patients treated operatively for extra-articular fractures in the neck or shaft of the 4th and 5th metacarpals. The second clinical study was a prospective, randomized controlled trial (RCT), comparing conservative and operative treatment of 5th metacarpal neck fractures. Paper two and three were methodological, radiological spin-off studies from the RCT. In paper two, we compared different methods for measuring volar angulation and shortening in 5th metacarpal neck fractures. In paper three, we presented a new definition of metacarpal neck area and metacarpal neck fractures.
List of papers. Papers I-III are removed from the thesis due to publisher restrictions.
Paper I Sletten IN, Nordsletten L, Husby T, Ødegaard RA, Hellund JC, Kvernmo HD. 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. J Hand Surg Eur Vol. 2012, 37: 387-95. doi:10.1177/1753193411431048
Paper II Sletten IN, Nordsletten L, Hjorthaug GA, Hellund JC, Holme I, Kvernmo HD. Assessment of volar angulation and shortening in 5th metacarpal neck fractures. An inter- and intra-observer validity and reliability study. J Hand Surg Eur Vol. 2013, 38: 658-66. doi:10.1177/1753193412461582
Paper III Sletten IN, Nordsletten L, Hjorthaug GA, Holme I, Hellund JC, Kvernmo HD. Identification of neck versus shaft fractures (INS method). A new definition of metacarpal neck area and metacarpal neck fractures. Manuscript.
Paper IV Sletten IN, Hellund JC, Olsen B, Clementsen S, Kvernmo HD, Nordsletten L. Conservative treatment without fracture reduction does not give worse clinical outcome than bouquet pinning of 5th metacarpal neck fractures. A multicenter, noninferiority, randomized, controlled trial of 85 patients with one year follow-up. Submitted version. Published as: J Hand Surg Eur Vol. 2013, Epub ahead of print November 26, doi:10.1177/1753193414560119