Effects of psychological factors on the clinical outcomes of fifth metacarpal neck fractures and their relation to injury etiology

BACKGROUND: The fifth metacarpal neck fracture injuries are commonly found in patients who applied to emergency clinics. The mechanism of trauma in these types of injuries seems to be different and, in some cases, appears to be intentional. Psychological factors play an important role in the treatment and rehabilitation, as well as in the etiology of metacarpal neck fractures. However, to the best of our knowledge, no research has yet compared the clinical outcomes of patients with fifth metacarpal neck fractures caused intentionally with those of patients with such fractures caused by unintentional injuries. Our goal is to investigate the relationships between the mechanism of injury, socioeconomic status, and clinical outcomes of patients with fifth metacarpal neck fractures.
METHODS: The study included 59 patients with fifth metacarpal neck fractures. The patients were separated into two groups. Group 1 consisted of patients with intentional injuries, and Group 2 consisted of patients with unintentional injuries. Both groups were evaluated in terms of the anger analysis, impulsivity, and the level of anxiety in relation to somatic findings Visual Analogue Scale (VAS) and The Disabilities of the Arm, Shoulder and Hand Score (QDASH). In addition, the relationship between anger, impulsivity, and anxiety scores with the socioeconomic status and educational level was assessed.
RESULTS: It was observed that the anger and impulsivity values of Group 2 patients were lower than the Group 1, and the decrease in Group 2 was correlated with the VAS and Q-DASH values. Group 1 barrat impulsivity score 61.5 (42–78), anxiety score 64 (55–77), state anger score 20 (16–30), and Group 2 barrat impulsivity score 61 (55–69), anxiety score 66 (58–72), and anger score 19 (14–26) were found as mean values. The impulsivity score and anger score were found to be lower in Group 2 at the low educational level. The number of patients with a low income was found to be high in both groups, and the impulsivity score and the anger score were higher in Group 1, while the anxiety score was higher in Group 2.
CONCLUSION: Sociodemographic factors and the etiology of intentional injuries could not be detected, but psychological factors play a role in the clinical sequelae of intentional fifth metacarpal fractures, their effects thereof on the hand function and the pain course after treatment.

Psikolojik faktörlerin beþinci metakarpal boyun kýrýklarýnýn klinik sonuçlarý üzerine etkileri ve yaralanma etiyolojisi ile iliþkisi

AMAÇ: Acil kliniðe baþvuran hastalar arasýnda 5. metakarp boyun kýrýðýna baðlý yaralanmalar yaygýndýr. Travma mekanizmasý çeþitli tiplerde olabildiði gibi bazý durumlarda istemli yaralanamalar görülebilmektedir. Beþinci metakarpal boyun kýrýk yaralanmalarý etiyolojiye baðlý olarak tedavi ve rehabilitasyon aþamalarýnda psikolojik faktörlerin önemli rolü olabilmektedir. Bu aþamada istemli veya istemsiz olarak meydana gelen yaralanmalarýnýn sonuçlarýnýn karþýlaþtýrýldýðý bir araþtýrma yapýlmamýþtýr. Bu çalýþmada, yaralanma mekanizmalarý arasýndaki sosyoekonomik düzey, eðitim seviyesi ve klinik sonuçlar arasýndaki iliþkiyi incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma metakarp boyun kýrýklý 59 hastayý kapsamaktadýr. Hastalar iki ayrý grup olarak deðerlendirildi. Grup 1 istemli yaralanmalý hastalar ve Grup 2 istemsiz yaralanmalý hastalar ile oluþturuldu. Her iki grup öfke analizi, dürtüsel düzey ve anksiyete düzeylerinin somatik bulgular VAS ve Q-DASH skorlarý ile olan iliþkisi açýsýndan deðerlendirildi. Ayrýca öfke, dürtüsellik ve anksiyete düzeylerinin sosyoekonomik ve eðitim seviyesi ile olan iliþkisi deðerlendirildi.
BULGULAR: Grup 2 hastalarda öfke ve dürtüsellik deðerleri Grup 1’e göre daha düþük olduðu ve Grup 2’deki bu düþük deðerlerin VAS ve Q-DASH skorýndaki düþüþle parelel olduðu görüldü. Grup 1 hastalarda Barrat dürtüsellik skor 61.5 (42–78), anksiyete skor 64 (55–77), öfke skoru 20 (16–30) ve Grup 2’de barrat dürtüsellik skor 61 (55–69), anksiyete skor 66 (58–72), öfke skoru 19 (14–26) ortalama deðer olarak bulundu. Eðitim düzeyi düþük olan hastalarda dürtüsellik skor deðerleri ve öfke skor deðerleri Grup 2’de düþük bulunmuþtur. Düþük gelire sahip hasta sayýsý her iki grupta yüksek olarak bulunmuþ ve bu hastalarda dürtüsellik skor deðeri, öfke skor deðeri Grup 1’de yüksek, anksiyete skor deðeri Grup 2’de yüksek olarak bulunmuþtur.
TARTIÞMA: Sosyodemografik faktörlerin ve etiyolojinin istemli yaralanma oluþmasýnda psikolojik faktörler açýsýndan etkinliði saptanamamýþ, ancak istemli beþinci metakarp boyun kýrýklarýn klinik olarak el fonksiyonlarý üzerindeki etkileri ve tedavi sonrasý aðrý seviyesinde etkili rol oynadýðý görülmüþtür.