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The Treatment of Metacarpal Fractures: Conservative Management May Be Better
Chelsea Snider, MD; Kate McKenna, BS; Kelli Webb, MD; Timothy Ade, BS; Mary Burns, OTR/L, CHT; Reuben Bueno, MD; Michael Neumeister, MD, FRCSC, FACS
Southern Illinois University, School of Medicine, Springfield, IL

Introduction: Metacarpal fractures account for twenty percent of all upper extremity fractures. Treatment of these common fractures varies widely, often based on surgeon experience and preference. The purpose of this study is to develop evidence-based recommendations for best practices in the treatment of metacarpal fractures.
Methods: We conducted an IRB approved retrospective review and clinical follow-up study of patients treated for metacarpal fractures at our institution over the last 5 years. Physical exam, hand therapy measurements, and valid patient questionnaire were conducted for critical analysis of non-operative and operative intervention for metacarpal fractures to assess complication rates, re-intervention rates, patient-centered outcomes (pain, stiffness, days off work, and cost), and functional outcomes (measured range of motion and grip strength).
Results: There were 902 patients identified as having received treatment for metacarpal fractures between years 2007-2012. Sixty-four patients returned for follow-up study; 52 received non-operative management and 12 received operative treatment, totally 60 fractures treated non-operatively and 17 treated operatively. Overall complication rate was 10.39%; 3.33% in the non-operative group and 35.29% in the operative group (p=0.0011). Decreased range of motion was seen in 5.0% of patients in the non-operative group and 35.3% of patients in the operative group (p=0.0018). Subjective pain and stiffness were reported similarly in both groups; however, average days off work were 36.14 in the non-operative group and 213 in the operative group (p=0.0088). Higher out-of-pocket cost for the patient was seen in the operative group, totally $3179.00 compared to $1037.50. Patients treated conservatively regained almost full grip strength and metacarpophalageal (MCP) joint flexion; there was no difference between flexion or extension of the injured and uninjured second through fifth digits. MCP joint flexion of all injured digits treated conservatively ranged from 82.91 to 86.46 degrees.
Conclusion: This retrospective review and follow-up clinical study demonstrate that non-operative treatment of metacarpal fractures results in decreased complication and re-intervention rates, and leads to overall improved patient satisfaction, earlier return to work, and decreased out-of-pocket cost for the patient. It is our current practice to offer non-operative management, including splinting and early range of motion, as first-line treatment for patients with metacarpal fractures. Surgical intervention is reserved for second-line intervention.


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