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Introduction: Fractures of the metacarpals encompass 18-44% of all hand fractures¹. The 5^th metacarpal is the most commonly fractured metacarpal, and fracture of the base is second only to metacarpal neck fractures². Despite the relatively common occurrence of this fracture, there is a paucity of evidence in the literature regarding patterns of injury and optimal treatment for fracture of the base of the 5^th metacarpal^3,4. This study aims to evaluate the incidence, distribution, mechanism of injury and treatment of fractures of the base of the 5^thmetacarpal, to further improve the management of such injuries.

Materials and Methods: A retrospective chart review was performed of 74 patients with fractures at the base of the 5^th metacarpal seen within a 5 year period (2011-2016). Patient demographics, mechanism of injury, intra- versus extra-articular, comminution, displacement, non-operative and operative treatment, time to surgery and follow-up time were collected. Fracture patterns were analyzed using Pearson's Chi-Squared Test to determine whether each variable influences operative vs. non-operative management.

Results: Most common mechanism of injury was punch (41.9%), fall (29.7%), and MVC (17.6%). 71.6% of patients were male and 28.4% were female. Average follow-up time was 35.19 ± 56.86 days, and 39.1% of patients lost to follow-up. Of the fractures, 17.7% were fully displaced, 44.6% were minimally displaced and 29.7% were non-displaced. 64.9% were intra-articular fractures and 43.1% were comminuted fractures. 18.9% of patients underwent operative treatment. Intra-articular fractures of the 5^th metacarpal were significantly more likely to require operative management than extra-articular fractures, p=0.015. Similarly, fully displaced fractures required operative treatment significantly more often than minimally displaced or nondisplaced fractures, p=0.047. Comminution had no significant effect on whether a fracture was managed operatively or non-operatively, p=0.57.

Conclusions: Although fractures of the base of the fifth metacarpal occur relatively frequently, there is no consensus for appropriate treatment. This study demonstrates that these fractures occur in a wide variety of patterns, and that particular features may increase the need for operative management. Articular involvement and fracture displacement had a significant effect on the decision to operate, while fracture comminution did not. Unfortunately, functional outcomes were limited due to poor patient follow-up. Further studies are needed to explore outcomes after operative and non-operative management of the various patterns of fracture at the base of the fifth metacarpal.