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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Utility of Follow-up Radiographs after Non-Operatively Managed Fifth Metacarpal Neck Fractures
Andrew R. Tyser, MD1; Erin Martens, MD2; Wyatt M Walsh, BS3; Anthony Montanez, MD3; (1)Department of Orthopaedics, University of Utah, Salt Lake City, UT, (2)IMS Orthopedics, Phoenix, AZ, (3)University of Utah, Salt Lake City, UT

Purpose

This study investigated the utility of radiographic examination of non-operatively managed fifth metacarpal neck fractures as a part of routine follow-up by comparing fracture angulation on injury films compared to those obtained during scheduled routine follow-up, and any change in management that occurred.

Methods

A retrospective review of patients who were initially treated non-operatively for isolated fifth metacarpal neck fractures was performed, and change in either fracture alignment or management in follow-up was investigated. A two, one-sided test (TOST) for equivalence was used to compare radiographic angulation (PA, oblique, and lateral) at injury and final time points, with the null hypothesis of no difference (> 10) between injury and follow-up lateral radiographs. A two-sided student's t-test was used to compare mean change in fracture angulation between the cast and splint treatment groups.

Results

After exclusion criteria were applied, 100 fractures in 99 patients were included in this study. The average patient age at the time of injury was 28 (range 9 82), and 80 patients were male (81%). Mean and standard deviation data regarding the initial angulation, follow-up angulation, and the difference in angulation between the two time-points are summarized in Table 1.

Table 2 summarizes relevant categorical data regarding changes in angulation and final radiographic outcomes. The null hypothesis of no mean difference (> 10) between injury and follow-up lateral radiographs was accepted. (p<0.05) No patient had a change from non-surgical to surgical management in this cohort.

Conclusion

The routine use of radiographic examination after initially non-operatively managed fifth metacarpal neck fractures does not appear to add to the treatment of this injury.

Table 1. Fracture angulation from injury to follow-up.


Mean (SD) radiographic fracture angulation (degrees) measured on PA, Oblique, and lateral views at injury and final time points, and the change between time points. Negative values represent a reduction in fracture angulation.

Table 2. Categorical radiographic outcome data.


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