Advertisement

Trends in the Management of Fifth Metacarpal Neck Fractures

Published:October 07, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.08.008

      Purpose

      To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED).

      Methods

      We identified all 5MCN fractures within our system for the years 2012–2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only.

      Results

      There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery.

      Conclusions

      Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences.

      Type of study/level of evidence

      Prognostic IV.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chung K.C.
        • Spilson S.V.
        The frequency and epidemiology of hand and forearm fractures in the United States.
        J Hand Surg Am. 2001; 26: 908-915
        • Frazier W.H.
        • Miller M.
        • Fox R.S.
        • Brand D.
        • Finseth F.
        Hand injuries: incidence and epidemiology in an emergency service.
        Am J Emerg Med. 1978; 7: 265-268
        • Bowman S.H.
        • Simon R.R.
        Metacarpal and phalangeal fractures.
        Emerg Med Clin North Am. 1993; 11: 671-702
        • Hove L.M.
        Fractures of the hand.
        Scand J Plast Reconstr Surg Hand Surg. 1993; 27: 317-319
        • Porter M.L.
        • Hodgkinson J.P.
        • Hirst P.
        • Wharton M.R.
        • Cunliffe M.
        The boxers' fracture: a prospective study of functional recovery.
        Arch Emerg Med. 1988; 5: 212-215
        • Smith M.E.
        • Auchincloss J.M.
        • All M.S.
        Causes and consequences of hand injury.
        J Hand Surg Eur. 1985; 10: 288-292
        • Greer S.E.
        • Williams J.M.
        Boxer's fracture: an indicator of intentional and recurrent injury.
        Am J Emerg Med. 1999; 17: 357-360
        • Gudmundsen T.E.
        • Borgen L.
        Fractures of the fifth metacarpal.
        Acta Radiol. 2009; 50: 296-300
        • Gladden J.R.
        Boxer's knuckle: a preliminary report.
        Am J Surg. 1957; 93: 388-397
        • Facca S.
        • Ramdhian R.
        • Pelissier A.
        • Diaconu M.
        • Liverneaux P.
        Fifth metacarpal neck fracture fixation: locking plate versus k-wire?.
        Orthop Traumatol Surg Res. 2010; 96: 506-512
        • Meals C.
        • Meals R.
        Hand fractures: a review of current treatment strategies.
        J Hand Surg Am. 2013; 38: 1021-1031
        • Padegimas E.M.
        • Warrender W.J.
        • Jones C.M.
        • Ilyas A.M.
        Metacarpal neck fractures: a review of surgical indications and techniques.
        Arch Trauma Res. 2016; 5e32933
        • Ali A.
        • Hamman J.
        • Mass D.P.
        The biomechanical effects of angulated boxer's fractures.
        J Hand Surg Am. 1999; 24: 835-844
        • Martínez-Catalán N.
        • Pajares S.
        • Llanos L.
        • Mahillo I.
        • Calvo E.
        A prospective randomized trial comparing the functional results of buddy taping versus closed reduction and cast immobilization in patients with fifth metacarpal neck fractures.
        J Hand Surg Am. 2020; 45: 1134-1140
        • Dunn J.C.
        • Kusnezov N.
        • Orr J.D.
        • Pallis M.
        • Mitchell J.S.
        The boxer's fracture: splint immobilization is not necessary.
        Orthopedics. 2016; 39: 188-192
        • Van Aaken J.
        • Fusetti C.
        • Luchina S.
        • et al.
        Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial.
        Arch Orthop Trauma Surg. 2016; 136: 135-142
        • Bansal R.
        • Craigen M.A.
        Fifth metacarpal neck fractures: is follow-up required?.
        J Hand Surg Eur. 2007; 32: 69-73
        • Boeckstyns M.E.
        Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically.
        J Hand Surg Eur. 2021; 46: 30-36
        • Van Aaken J.
        • Kampfen S.
        • Berli M.
        • Fritschy D.
        • Della Santa D.
        • Fusetti C.
        Outcome of boxer’s fractures treated by a soft wrap and buddy taping: a prospective study.
        Hand. 2007; 2: 212-217
        • Ozturk I.
        • Erturer E.
        • Sahin F.
        • et al.
        Effects of fusion angle on functional results following non-operative treatment for fracture of the neck of the fifth metacarpal.
        Injury. 2008; 39: 1464-1466
        • Lowdon I.M.
        Fractures of the metacarpal neck of the little finger.
        Injury. 1986; 17: 189-192
        • Leung Y.L.
        • Beredjiklian P.K.
        • Monaghan B.A.
        • Bozentka D.J.
        Radiographic assessment of small finger metacarpal neck fractures.
        J Hand Surg Am. 2002; 27: 443-448
        • Sletten I.N.
        • Hellund J.C.
        • Olsen B.
        • Clementsen S.
        • Kvernmo H.D.
        • Nordsletten L.
        Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients.
        J Hand Surg Eur. 2015; 40: 76-83
        • Strub B.
        • Schindele S.
        • Sonderegger J.
        • Sproedt J.
        • Von Campe A.
        • Gruenert J.G.
        Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? a prospective study.
        J Hand Surg Eur. 2010; 35: 725-729
        • Gruson K.I.
        • Huang K.
        • Wanich T.
        • DePalma A.A.
        Workers’ compensation and outcomes of upper extremity surgery.
        J Am Acad Orthop Surg. 2013; 21: 67-77
        • Day C.S.
        • Alexander M.
        • Lal S.
        • et al.
        Effects of workers' compensation on the diagnosis and surgical treatment of patients with hand and wrist disorders.
        J Bone Joint Surg Am. 2010; 92: 2294-2299
        • Duncan S.F.
        • Calandruccio J.H.
        • Merritt M.V.
        • Crockarell J.R.
        • Kakinoki R.
        A comparison of workers' compensation patients and nonworkers' compensation patients undergoing endoscopic carpal tunnel release.
        Hand Surg. 2010; 15: 75-80
        • Druss B.G.
        • Rosenheck R.A.
        Mental disorders and access to medical care in the United States.
        Am J Psychiatr. 1998; 155: 1775-1777
        • Kuokkanen H.O.
        • Mulari-Keranen S.K.
        • Niskanen R.O.
        • Haapala J.K.
        • Korkala O.L.
        Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting.
        Scand J Plast Reconstr Surg Hand Surg. 1999; 33: 315-317
        • Ring D.
        Malunion and nonunion of the metacarpals and phalanges.
        J Bone Joint Surg Am. 2005; 87: 1380-1388
        • Jupiter J.B.
        • Koniuch M.P.
        • Smith R.J.
        The management of delayed union and nonunion of the metacarpals and phalanges.
        J Hand Surg Am. 1985; 10: 457-466
        • Hammert W.C.
        Treatment of nonunion and malunion following hand fractures.
        Clin Plas Surg. 2011; 38: 683-695
        • Mills L.A.
        • Simpson A.H.
        The relative incidence of fracture non-union in the Scottish population (5.17 million): a 5-year epidemiological study.
        BMJ Open. 2013; 3e002276
        • Mills L.
        • Aitken S.
        • Simpson A.H.
        The risk of nonunion per fracture: current myths and revised figures from a population of over 4 million adults.
        Acta Orthop. 2017; 88: 434-439
        • Zura R.
        • Xiong Z.
        • Einhorn T.
        • et al.
        Epidemiology of fracture nonunion in 18 human bones.
        JAMA Surg. 2016; 151e162775