gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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A prospective randomized trial comparing clinical outcomes of treatment with buddy taping of 4th and 5th metacarpal vs closed reduction and cast immobilization in fifth metacarpal neck fractures with less than 70º of volar angulation

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  • presenting/speaker Natalia Martinez Catalan - Hospital Fundacion Jimenez Diaz, Madrid, Spain
  • Samuel Pajares Cabanillas - Hospital Fundación Jimenez Diaz, Madrid, Spain
  • Emilio Calvo Crespo - Hospital Fundacion Jimenez Diaz, Madrid, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1876

doi: 10.3205/19ifssh0789, urn:nbn:de:0183-19ifssh07897

Published: February 6, 2020

© 2020 Martinez Catalan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The ideal treatment for fifth metacarpal neck fractures is still under debate. Although these fractures are typically treated nonoperatively, most often with closed reduction and splint immobilization, cast immobilization seems to not be superior to soft wrap without reduction in most cases.

The aim of this study was to determine if the outcomes of buddy taping for three weeks was not inferior to reduction and cast immobilization for fifth metacarpal neck fractures with volar angulation < 70° and no rotational deformity.

Methods: Between August 2016 and March 2018, 72 patients with fifth metacarpal neck fractures were prospectively enrolled and treated with buddy taping or a cast with previous reduction during 3 weeks according to an established randomization sequence. All patients were monitored at 3 and 9 weeks after fracture and the primary outcome was measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Range of motion (ROM) of the metacarpal phalangeal (MCP) joint, pain, grip strength, return to work, radiographic angulation and complications were recorded.

Results and Conclusions: After 3 weeks, patients treated with buddy taping were satisfied with good fifth MCP joint ROM and their DASH score was significantly lower than the other group.

At 9 weeks, clinical outcomes in the soft wrap group were better in terms of grip strength, range of motion and score obtained in DASH questionnaire, but this statistical difference was without clinical relevance.

A subjective long-term evaluation was performed by phone; at a median of 1 year, a QuickDash score gave a median of 0 points. There were more complications in the group of patients treated with cast immobilization. Increased fracture angulation was not significantly different between the groups. Duration of time off work was 28 days shorter with the soft wrap compared to the cast treatment (P <0.001).

There is no benefit to reduction and splint immobilization of fifth metacarpal neck fractures with initial angulation of less than 70°. The use of soft wrap and buddy taping with early mobilization resulted in satisfied patients, good clinical results and significant improvement in lost work time.