Clinical Outcomes of Severely Angulated Fifth Metacarpal Neck Fractures Treated Nonsurgically

• Published in: Hand (New York, N.Y.) Vol. 18; no. 4; pp. 604 - 611
• Main Authors: France, Thomas J., Leversedge, Fraser J., Lauder, Alexander
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.06.2023
• Subjects: Fracture Fixation, Intramedullary; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Hand Injuries - surgery; Humans; Metacarpal Bones - injuries; Treatment Outcome; patient-reported outcomes; severe deformity; nonoperative treatment; fifth metacarpal neck fracture; severe angulation; boxer fracture; malrotation; scissoring
• ISSN: 1558-9447; 1558-9455
• DOI: 10.1177/15589447211063238

Background: Reasonable functional outcomes for nonoperative management of isolated, closed fifth metacarpal neck fractures with up to 70° angulation have been reported; however, reported outcomes for fractures with greater than 70° angulation are limited. This study describes clinical outcomes of nonsurgically treated fifth metacarpal neck fractures with angulation of greater than 70°. Methods: A retrospective review of patients treated between May 1, 2016, and May 1, 2020, included: (1) patients aged 18 years and above with an isolated, closed, fifth metacarpal neck fracture; (2) nonsurgical treatment; (3) healed fractures with angulation greater than 70° measured on oblique radiographs; and (4) minimum 6-month follow-up after injury. Photographic hand motion and patient-rated outcomes (Functional Hand Scale, Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], 12-item Short-Form Health Survey [SF-12]) were collected and reported. Results: A total of 364 fractures were identified; 11% (40/364) demonstrated angulation of greater than 70° (range: 71°-82°); and 15 patients (inclusion rate: 38%, 15/40) with mean fracture angulation of 73° (range: 71°-77°) participated in the study. Mean follow-up was 32 months (range: 8-120 months), the dominant hand was injured in 87% (13/15) of patients, and 47% (7/15) of patients worked in manual labor. All patients scored the highest rating of “very good” (range: 26-30 of 30 points) on the functional hand scale. A QuickDASH score of zero (no morbidity) was reported in 80% (12/15) of patients. About 87% (13/15) of patients had average or above-average scores on the SF-12 (mean = 109, range: 84-115). Conclusions: Patients with healed, isolated, closed fifth metacarpal neck malunions with severe angulation greater than 70° demonstrated acceptable functional outcomes based on patient-rated outcomes scoring.