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

Abstract

IntroductionMetacarpal shaft fractures (MSF) are common traumatic hand injuries that usually affect young people of working age. They place a significant burden on healthcare resources and society; however, there is a lack of evidence to guide their treatment. Identifying the most beneficial and cost-efficient treatment will ensure optimisation of care and provide economic value for the National Health Service. The aim of this study is to assess the feasibility of a randomised controlled trial comparing surgical and non-surgical treatment for MSF in adults.Methods and analysisThis is a multicentre prospective cohort study, with a nested qualitative study consisting of patient interviews and focus groups, and an embedded factorial randomised substudy evaluating the use of text messages to maximise data collection and participant retention. The outcomes of interest include eligibility, recruitment and retention rates, completion of follow-up, evaluation of primary outcome measures, calculation of the minimal clinically important difference (MCID) for selected outcome measures and establishing the feasibility of data collection methods and appropriate time-points for use in a future trial. Data will be captured using a secure online data management system. Data analyses will be descriptive and a thematic inductive analysis will be used for qualitative data. Minimum clinically important effects for each patient-reported outcome measure will be estimated using anchor-based responsiveness statistics and distribution-based methods.Ethics and disseminationThis study has received ethical approval from the Research Ethics Committee and the Health Research Authority (REC reference 20/EE/0124). Results will be made available to patients, clinicians, researchers and the funder via peer-reviewed publications and conference presentations. Social media platforms, local media and feedback from the Patient Advisory Group will be used to maximise circulation of findings to patients and the public.Trial registration numberISRCTN13922779.

Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures

“…Sick leave duration was significantly lower in the nonoperative group (12 days) than in the operative group (35 days). Most patients with finger MSFs are of working age, and the economic burden of finger MSFs has been discussed in detail by Taha et al 3 . In our study, the costs for operative treatment were higher than those for nonoperative treatment, without inclusion of the societal costs of sick leave and the complications that occurred exclusively in the operative group.…”

“…There is inadequate evidence to indicate whether operative or nonoperative treatment is better for treating finger MSFs 2,3 . Because of the lack of randomized controlled trials (RCTs) evaluating this fracture type, we conducted this noninferiority study of spiral and/or oblique displaced finger MSFs with or without rotational deformity; we compared nonoperative treatment with unrestricted mobilization to operative treatment with interfragmentary compression screws.…”

“…Most patients are of working age; therefore, MSFs result in high societal costs due to reduced ability to work during treatment and recovery 2 . However, the exact costs are unknown for these injuries 3 .…”

Curative effect of external fixation combined with kirschner wire versus hollow screw in the treatment of first metacarpal bone base fracture

“…Moreover, the thumb plays a vital role in hand function, and inadequate treatment can significantly impair hand function. Therefore, surgery has become the preferred for this type of fracture in recent years [ 5 ]. Surgical options include small splint fixation, conventional manual reduction, plaster fixation and plate or Kirschner wire internal fixation.…”