Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

Abstract

Metacarpal fractures are among the more common fractures of the upper extremity (1-7), accounting for 18% of all below-elbow fractures in the United States (5). Freehan and Sheps (8) reported that metacarpal fractures represented 42% of 72,481 reviewed cases of hand fractures. Spiral metacarpal fractures commonly result in some shortening of the metacarpal shaft (9), which may subsequently cause extension lag at the metacarpophalangeal (MCP) joint and reduced grip strength (9-13). Several studies have documented the relationship between shortening and hand function (1,9,12,(14)(15)(16)(17)(18)(19)(20)(21), although the maximum amount of shortening that occurs following metacarpal fracture and acceptable limits appear to be controversial.Historically, spiral fractures occurring without scissoring have been treated surgically to restore metacarpal length and prevent these losses in power and function. Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss. Furthermore, one must consider the cost, complications and consequences associated with surgery, postoperative management and wound healing.Increasingly, conservative management of nonscissoring spiral metacarpal fractures has come into favour in the absence of absolute indications for a surgical approach (10,11,16,32). Despite potential shortening of the metacarpal, a nonoperative approach preserves the integrity of the intrinsic muscles of the hand, thereby benefiting functional recovery, while also avoiding the aforementioned consequences and costs of surgery. Unfortunately, however, few studies exist documenting the long-term natural history of unoperated spiral metacarpal fractures. The purpose of the present study was, therefore, to investigate this outcome.We conducted a prospective consecutive case series of unoperated, nonscissoring spiral metacarpal fractures to document the effect of conservative management on resultant power in the hand despite the metacarpal shortening that is often associated with these fractures. BACKgROUND: Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand. OBJECTIVE: To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures. METHODS: Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural histor...

Predicting metacarpal length using paired ratios with bilateral X-ray films

“…We were able to find one study in the literature following 13 unoperated, non-scissoring spiral metacarpal fractures for grip strength outcomes. 22 While these patients did not have significant reductions in grip strength (compared to the uninjured contralateral hand), hand dominance was not accounted for and no attempt was made to estimate the degree of shortening. Future studies should cover a larger sample size and include additional functional outcomes such as total active range of motion and pinch strength.…”

Protocol for surgical and non-surgical treatment for metacarpal shaft fractures in adults: an observational feasibility study

“…This was supported by previous studies of MSF reporting full range of motion in almost all patients by 6 months. 17 Furthermore, previous studies in similar patient cohorts with follow-up of 12 months or longer suffered high drop-rates or struggled to recruit adequate numbers of participants. A participant pathway flowchart is illustrated in figure 1.…”

Hand Rehabilitation Programs Used for Second to Fifth Metacarpal Fractures: A Systematic Literature Review Protocol

“…Management of second to fifth metacarpal fractures varies in literature and is dependent on, but not limited to, the follow factors: surgical or conservative medical management, area of fracture, angulation, rotation and shortening of the metacarpal bone. Literature relating to hand rehabilitation after surgical and conventional management will be provided [6][7][8][9][10].…”