The effectiveness of closed reduction of small finger metacarpal neck fractures: a prospective analytical study

Pinchai O; Jirathitiwong P

Authors

Pinchai O Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Jirathitiwong P Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Keywords:

small finger metacarpal neck fracture, fifth metacarpal fracture, boxer’s fracture, metacarpal fracture, subcapital fracture of metacarpal bone, closed reduction.

Abstract

Objectives To prospectively assess the effectiveness of closed reduction of small finger metacarpal neck fractures in terms of the extent to which the reduced fracture angulation can be maintained at 2 weeks and 4 weeks after reduction by using a plaster ulnar gutter splint.
Methods This prospective, descriptive, single-center study evaluated patients who presented between January 2015 and January 2020 with greater than 40 degrees of angulation within 1 week of a small finger metacarpal neck fracture. The degree of fracture angulation was measured in oblique view from digital radiographs at pre-reduction, immediate post-reduction, 2 weeks post-reduction and 4 weeks post-reduction.
Results Forty-three of 67 patients were treated for small finger metacarpal neck fractures of whom 24 were excluded and 19 patients were included in the study. There was a highly significant decrease in fracture angulation at 4 weeks post reduction of from 48.05 degrees pre-reduction to 42.53 degrees (p = 0.006). There was a very highly significant increase in fracture angulation from 36.16 degrees immediately post reduction to 42.53 degrees at 4 weeks post reduction (p < 0.001).
Conclusion Initial reduction of fracture angulation cannot be fully maintained in a plaster ulnar gutter splint at 2 weeks and 4 weeks after reduction, but the angulation at 4 weeks after reduction provides an effective reduction when compared with the pre-reduction angulation. Closed reduction and immobilization in a plaster ulnar gutter splint of small finger metacarpal neck fractures is an effective method of angulation reduction.

References

Hunter JM, Cowen NJ. Fifth metacarpal fractures in a compensation clinic population. A report on one hundred and thirty-three cases. J Bone Joint Surg Am. 1970;52:1159-65.

Lowdon IM. Fractures of the metacarpal neck of the lit-tle finger. Injury. 1986;17:189-92.

McCue FC, 3rd, Meister K. Common sports hand inju-ries. An overview of aetiology, management and pre-vention. Sports Med. 1993;15:281-9.

Van AJ, 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 (N Y) 2007;2:212-7.

Hansen PB, Hansen TB. The treatment of fractures of the ring and little metacarpal necks. A prospective ran-domized study of three different types of treatment. J Hand Surg Br. 1998;23:245-7.

Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg. 2003;123:534-7.

Hofmeister EP, Kim J, Shin AY. Comparison of 2 meth-ods of immobilization of fifth metacarpal neck frac-tures: a prospective randomized study. J Hand Surg Am. 2008;33:1362-8.

Pace GI, Gendelberg D, Taylor KF. The effect of closed reduction of small finger metacarpal neck fractures on the ultimate angular deformity. J Hand Surg Am. 2015;40:1582-5.

Jahss SA. Fractures of the metacarpals. A new method of reduction and immobilization. J Bone Joint Surg. 1938;20:178-86

Lamraski G, Monsaert A, De Maeseneer M, Haentjens P. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res. 2006;24:37-45.

Konradsen L, Nielsen PT, Albrecht-Beste E. Functional treatment of metacarpal fractures 100 randomized cases with or without fixation. Acta Orthop Scand. 1990; 61:531-4.

Kuokkanen HO, Mulari-Keranen SK, Niskanen RO, Haapala JK, Korkala OL. Treatment of subcapital frac-tures of the fifth metacarpal bone: a prospective ran-domised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg. 1999;33:315-7.

McMahon PJ, Woods DA, Burge PD. Initial treatment of closed metacarpal fractures. A controlled compari-son of compression glove and splintage. J Hand Surg Br. 1994;19:597-600.

Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005;3:CD003210.

Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am. 1999; 24:835-44.

Ford DJ, Ali MS, Steel WM. Fractures of the fifth meta-carpal neck: is reduction or immobilisation necessary? J Hand Surg Br. 1989;14:165-7.

Braakman M, Oderwald EE, Haentjens MH. Function-al taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998;29:5-9.

Kilbourne BC, Paul EG. The use of small bone screws in the treatment of metacarpal, metatarsal and phalangeal fractures. J Bone Joint Surg. 1958;40:375.

Green DO, Wolfe SW, Hotchkiss RN. Green’s operative hand surgery. 7th ed. Philadalphia: Elsevier; 2017.

Bansal R, Craigen MA. Fifth metacarpal neck frac-tures: Is follow-up required? J Hand Surg Eur. 2007;32: 69-73.

Tavassoli J, Ruland RT, Hogan CJ, Christopher J, Can-non DL. Three cast techniques for the treatment of extra-articular metacarpal fractures: comparison of short-term outcomes and final fracture alignments. J Bone Joint Surg Am. 2005;87:2196-201.