The effectiveness of closed reduction of small finger metacarpal neck fractures: a prospective analytical study
Keywords:small finger metacarpal neck fracture, fifth metacarpal fracture, boxer’s fracture, metacarpal fracture, subcapital fracture of metacarpal bone, closed reduction
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.
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