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Does Attempted Reduction of Isolated Small Finger Metacarpal Neck Fractures Reduce the Measured Angular Deformity at Final Follow-up?
Gregory I. Pace, MD; David Gendelberg, MD; Kenneth F. Taylor, MD
Pennsylvania State College of Medicine, Hershey, PA

Hypothesis: Current recommendations for the treatment of boxer's fractures are highly variable and reduction of these fractures is often performed in an effort to decrease the residual deformity upon healing. We hypothesize that attempted closed reduction of fifth metacarpal neck fractures does not result in decreased fracture angulation at final follow-up.

Methods: Retrospective chart review of all patients aged 18 and older managed for isolated boxer's fractures between 2004 and 2014. Subjects were separated into two groups; patients who underwent an attempted fracture reduction at the initial visit, and patients who did not undergo an attempted fracture reduction. The degree of fracture angulation was measured on oblique radiographs by two independent observers as per the procedures described by Lowdon et al. in which they determined the normal uninjured head/shaft angle at the fifth metacarpal neck as viewed on oblique radiographs to be approximately 26 degrees. To analyze interobserver reliability, the intraclass correlation coefficient was determined. Significance was measured using the paired t-test when comparing the initial, post-reduction, and final fracture angle measurements within the reduction and non-reduction groups, and the student's t-test was used when comparing the change in fracture angle between the two groups.

Results: Sixty-six patients meeting the inclusion criteria were managed for an isolated boxer's fracture during the study period. Twenty-three patients underwent attempted reduction and 43 patients did not. The average initial fracture angulation for all patients was 46.8 degrees. For patients who underwent an attempted fracture reduction at the initial visit there was a significant decrease in fracture angle following reduction (49.0 degrees vs. 39.6 degrees; p<0.05), however the initial and last follow-up fracture angulation for patients undergoing a reduction attempt was not significantly different (49.0 degrees vs. 44.9 degrees; p=0.09). For patients without a reduction attempt the average fracture angle was 45.5 degrees at the initial visit and 45.0 degrees at last follow-up (p=0.55). When comparing the average change in fracture angle from the initial visit to final follow-up there was no difference between patients with and without a reduction attempt (4.1 degrees vs. 0.5 degrees; p=0.16). Interobserver reliability was high for each set of radiographs measured.

Conclusion: The attempted reduction of fifth metacarpal neck fractures is not an effective means of achieving a significant improvement in fracture alignment upon healing. Therefore, closed reduction with pin fixation or open reduction with internal fixation should be utilized when maintenance of a significant reduction is desired.

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