Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures

Abstract

Background: Finger metacarpal fractures represent up to 31% of all hand fractures, and most can be treated nonoperatively. Whether operative treatment is superior to nonoperative treatment for oblique and/or spiral finger metacarpal shaft fractures (MSFs) is unknown.Methods: Forty-two patients with displaced oblique and/or spiral finger MSFs were randomized to either nonoperative treatment with unrestricted mobilization or operative treatment with screw fixation. The primary outcome was grip strength in the injured hand compared with the uninjured hand at the 1-year follow-up. Secondary outcomes were the Disabilities of the Arm, Shoulder and Hand score, range of motion, metacarpal shortening, complications, sick leave duration, patient satisfaction, and costs.Results: All patients attended the 1-year follow-up. Mean grip strength relative to that in the contralateral hand was 104% (95% confidence interval [CI], 89% to 120%) in the nonoperative group and 96% (95% CI, 89% to 103%) in the operative group (p = 0.34). Mean metacarpal shortening was 5.3 mm (95% CI, 4.2 to 6.4 mm) in the nonoperative group and 2.3 mm (95% CI, 0.8 to 3.9 mm) in the operative group. In the nonoperative group, 1 minor complication was observed; in the operative group, there were 4 minor complications and 3 reoperations. The costs were estimated at 1,347 U.S. dollars (USD) for nonoperative treatment compared with 3,834 USD for operative treatment. Sick leave duration was significantly shorter in the nonoperative group (12 days [95% CI, 5 to 21 days] versus 35 days [95% CI, 20 to 54 days]) (p = 0.008).Conclusions: When treated with unrestricted mobilization, patients with a single displaced spiral and/or oblique finger MSF have outcomes comparable to those treated operatively, despite metacarpal shortening. Costs are substantially higher (2.8 times) and sick leave is significantly higher in the operative group.

Conservative treatment versus transverse pinning in fifth metacarpal neck fractures in active adults: a randomized controlled trial

“…However, in a study conducted by Fredrik Peyronson et al in which conservative treatment was compared to operative management in metacarpal fractures, a linear regression analysis showed that the grip strength was better in the dominant hand by 22.2% when compared to the non-dominant side ( p Value = 0.007). [ 28 ]…”

Surgical complications: errors and adverse events

“…Knowledge can be critical in decision making and patient counselling. Recent research has shown that non-operative treatment of spiral metacarpal fractures is so good that surgery is rarely going to give a better outcome (Khan and Giddins, 2015; Peyronson et al., 2022). Few patients will choose surgery if advised of that, but a less informed surgeon may recommend surgery meaning any adverse outcomes of that treatment could be a result of their error.…”

Wrist & Hand

“…A group from Uppsala (Sweden) have performed a prospective noninferiority randomized controlled trial to compare nonoperative and operative treatment for displaced finger metacarpal shaft fractures. 8 Overall, 42 patients with oblique or spiral fractures were randomized to screw fixation or nonoperative treatment with unrestricted mobilization. The primary outcome measure was grip strength in the hand, which was injured as compared with the uninjured hand at 12 months’ follow-up.…”