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Evaluating Operative And Nonoperative Trends For Second Through Fifth Metacarpal Base Fractures: A Trinetx Database Study
Michael G Flood, MD
1, Gregory Iovanel, MD
1, Gianna Guarino, MD
1, Matthew DeFazio, MD
1, Saoirse Connolly, BS
1, Muntazim Mukit, MD
1, Marci Jones, MD
2; Michael DiBenedetto, MD
1(1)UMass Chan, Worcester, MA, (2)Department of Orthopedics, University of Massachusetts, Worcester, MA
Introduction: While metacarpal fractures account for roughly 40% of all hand fractures, second through fifth metacarpal base fractures are less common and there remains a paucity of literature regarding their management.1 This study evaluates current trends in management utilizing national, de-identified data. We hypothesized that factors associated with increased rates of operative management would include displacement and younger age. We also hypothesized that the fourth and fifth metacarpals would undergo surgery more frequently compared with second and third due to increased intrinsic instability.
Materials and Methods: Utilizing the TriNetX database, we identified isolated, closed, metacarpal base fractures without dislocation or other associated hand/wrist injury (ie blood vessel, nerve, tendon injury) in academic and non-academic institutions. We identified the rates of operative intervention by including specific CPT codes (26608-percutaneous skeletal fixation; 26615-open treatment of metacarpal fracture; 26607-closed treatment with external or internal fixation, 26685-open treatment of CMC dislocation other than first metacarpal). Using Chi-squared analysis, we evaluated multiple factors including displacement, dislocation, demographic data, and the metacarpal affected.
Results: The overall percentage of non-dislocated metacarpal base fractures managed surgically was 5.07%. Displaced fractures were treated operatively in 7.55% of patients compared with 1.58% in nondisplaced fractures. The operative rates for second, third, fourth, and fifth metacarpals were 3.90%, 4.60%, 6.25%, and 4.95% respectively. Fifth metacarpal fractures were the most common fracture and involved the most overall procedures. 5.84% of male patients underwent surgical intervention compared with 3.60% of females. There was a bimodal distribution with higher frequency among young males and older females, with males accounting for nearly 60% of total patients. White and black patients underwent surgical intervention in 5.26% vs 4.76% of patients. The operative and nonoperative groups had an average age of 41 (SD=16) and 46 (SD=20), respectively. Fractures with associated CMC dislocations underwent surgery in 20.06% of cases.
Conclusions: Closed, isolated base fractures of the second through fifth metacarpal without associated dislocation are most commonly treated without operative intervention. Factors associated with higher rates of surgical management include younger age, fracture displacement, male sex, presence of dislocation, white race, and the specific metacarpal affected, with the fourth metacarpal most frequently treated operatively. This study identifies factors which increase risk for operative management and provides a strong baseline for further investigation into the management of metacarpal base fractures.
1: Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y). 2014;9(1):16-23. doi:10.1007/s11552-013-9562-1
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