gms | German Medical Science

Objectives/Interrogation: Metacarpal neck fractures are frequent injuries in the young male working population and controversy between surgical and conservative management exists for severely angulated fractures. The aim of this retrospective case series is to compare the functional outcomes of conservative and surgical treatment of closed metacarpal neck fractures with more than 50 degree angulation.

Methods: We reviewed 135 consecutive metacarpal neck fractures that were managed at our center over a 2-year period (2016-2017). 28 closed fractures showing more than 50 degree angulation in oblique xray view were retrospectively reviewed. A demographic and clinical comparison was made between fractures managed conservatively (group A) vs surgically (group B). Clinical outcome was determined measuring grip strength and metacarpophalangeal joint active range of motion.

Results and Conclusions: Of the 28 fractures reviewed, 3 were work related injuries, of which 1 was high energy impact, 27 patients were male with mean age of 34.5 years. Most common metacarpal bone affected was 5th (25 fractures) followed by 4th (3 fractures). Patients were classified into two groups: group A was treated with splint (ulnar gutter splint) or cast immobilization and group B was managed surgically with percutaneous pinning (4 fractures) or ORIF (6 fractures). Mean difference between grip strength for group A was 10.7kg and 7,8kg for group B. Range of motion in group A was 0-69 degrees and 0-65 degrees for group B. Only one complication was noted in conservative group (nonunion).

Conservative management in terms of splinting of metacarpal neck fractures with angulation greater than 50 degrees has a functional outcome comparable to those managed surgically with a low rate of complications.