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American Association for Hand Surgery

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A 14-Year Review of Clinical Practice Patterns in Metacarpal Fracture Repair Based on Continuous Certification by the American Board of Plastic Surgery
Daniel Cyrus Sasson, BA1, Nikhil D Shah, BS1, Selcen Sila Yuksel, BS1, Aaron M Kearney, MD2, Keith Brandt, MD3 and Arun K Gosain, MD4, (1)Ann and Robert H. Lurie Children's Hospital, Chicago, IL, (2)Ann & Robert H. Lurie Children's Hospital, Chicago, IL, (3)American Board of Plastic Surgery, Philadelphia, PA, (4)Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, IL

Background
The American Board of Plastic Surgery has been collecting practice data on metacarpal fracture repair since 2006 as part of its Continuous Certification process. This data allows plastic surgeons to compare their surgical experience to national trends. Additionally, this data presents the opportunity to analyze those trends in relation to evidence-based medicine (EBM).
Methods
Data on metacarpal fracture repair from May 2006 - December 2014 were reviewed and compared to those from January 2015 - March 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and EBM.
Results
1160 metacarpal fracture repair cases were included from May 2006 - March 2020. The average patient age was 29 years, and 78% identified as male. 87% of fractures were closed. Most fractures (48%) presented on the bone shaft, followed by the neck (24%). Fractures of the fifth metacarpal and fourth metacarpals were most common (52% and 32%, respectively). In terms of fracture pattern, 43% were transverse, 38% oblique, and 33% comminuted. 20% of patients experienced more than one metacarpal fracture.
Outpatient (as opposed to inpatient) operative repairs have been trending upwards, from 50% to 61% (p<0.001). Most repairs were performed under general anesthesia (68%), and there was a decrease in the use of regional anesthesia between our two cohorts (14% to 9%; p=0.01, Table 1). An open reduction with internal fixation was the most popular technique (51%), and a decrease in the use of closed reduction with splinting was observed (16% to 10%; p=0.001, Table 2). Stiffness was the most commonly reported adverse event. Topics addressed in EBM articles but not tracer data included interosseous wiring, which has shown success in spiral shaft fracture treatment with minimal complications, and non-operative management.
Conclusions
As evidence-based recommendations continue to change with additional research inquiry, tracer data can provide an excellent overview of the current practice of metacarpal fracture repair and how effectively physicians adapt to remain aligned with best practices.


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