gms | German Medical Science

Objectives/Interrogation: Management of fifth metacarpal neck fractures lacks consensus and is highly variable throughout the available literature. Our study aims to examine patterns and trends in nonoperative treatment, surgical indications, and surgical techniques for fifth metacarpal neck fractures amongst hand surgeons of different demographic backgrounds within the US.

Methods: A survey consisting of 18 questions was hosted online and distributed to the members of the American Society for Surgery of the Hand (ASSH) via email. Questions sought to determine the demographics of the surgeon, preferred initial treatment for metacarpal fractures of varying degrees of angulation, preferred immobilization technique, factors leading to surgical intervention, and preferred technique for surgical intervention. Responses were analyzed for significant patterns and trends.

Results and Conclusions: A total of 581 responses were received (17% response rate). The majority of respondents utilize intramedullary lines on lateral radiographs to measure fracture angulation, prefer splinting in the intrinsic-plus position for fracture immobilization, and prefer closed reduction and percutaneous pinning for surgical management. Average measurements to indicate patients for surgery were 9.2* of rotation, 41.6* of sagittal malalignment, 20.2* of coronal malalignment, or 6.1 mm of shortening. On average, orthopaedic surgeons tolerated greater degrees of volar angulation (43.8*) than general surgeons (30.7*) or plastic surgeons (27.9*).

Our study reveals several significant differences regarding the management of fifth metacarpal neck fractures between hand surgeons with different residency backgrounds, variable years of experience, and in different practice settings. Geographic region of practice and primary consultant were less impactful. Ultimately, management decisions appear to be a result of patient-specific factors as well as surgeon preference.