Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

Abstract

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. Study Design: Systematic review; Level of evidence, 4. Methods: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL. Results: Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized. Conclusion: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

“…4,5,7 In athlete-related metacarpal injuries, there is a focus on a quick return to sport. 14,15 Fractures treated with splinting and early ROM all returned to pre-fracture activity within an average of twenty-two days 17 and were shown to have equivalent total active motion versus surgically managed fractures in long-term follow-up. 16 Interestingly, surgically managed injuries in athletes had a longer return to play (29 days vs 22 days) in Geoghegan et al's study.…”

“…Splinting alone for minimally displaced metacarpal fractures was shown to have an average return to play in the athlete population of 22 days. 17…”

“…9 Significant attention has been paid to the athlete population when it comes to metacarpal fractures as this group tends to have a higher demand for early return to play. [14][15][16][17] It is recognized that this group often has minimally displaced injuries and often benefits from immobilization and early range of motion (ROM) versus surgery. 15 Long-term outcomes are equal in conservative versus operative management for minimally displaced fractures, 16 and cases undergoing surgery have a longer return to play than those not operated upon.…”

“…15 Long-term outcomes are equal in conservative versus operative management for minimally displaced fractures, 16 and cases undergoing surgery have a longer return to play than those not operated upon. 17 This longer return to play is affected by the delay in waiting for surgery. Splinting alone for minimally displaced metacarpal fractures was shown to have an average return to play in the athlete population of 22 days.…”

“…Splinting alone for minimally displaced metacarpal fractures was shown to have an average return to play in the athlete population of 22 days. 17 When determining which joints to immobilize, the standard rule for fractures is "the joint above and below" but this rule is often broken. Distal radius fractures and ankle fractures being classic examples where the elbow and knee respectively are not immobilized.…”