Nonthumb metacarpal (NTMC) fractures are common in the incarcerated and the underinsured civilian populations. However, certain social challenges contribute to high rates of follow-up noncompliance and complications in these unique populations. We conducted a retrospective review of the treatments, outcomes, and complications in the incarcerated and civilian patient population who were treated at a tertiary public hospital for NTMC fractures. Even though incarcerated patients were more likely than their civilian counterparts to undergo operative interventions, both populations showed similar complication profiles as well as low rates of treatment compliance and follow-up. This article affirms that incarcerated individuals do not receive inferior care compared with civilians, and both the incarcerated and underinsured civilians would benefit from careful consideration of treatment algorithms and additional access to hand therapy.
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References
1.
BalaramA. K., & BednarM. S. (2010). Complications after the fractures of metacarpal and phalanges. Hand Clinics, 26(2), 169–177. https://doi.org/10.1016/j.hcl.2010.01.005
2.
BansalR., & CraigenM. A. (2007). Fifth metacarpal neck fractures: Is follow-up required?. Journal of Hand Surgery, 32(1), 69–73. https://doi.org/10.1016/j.jhsb.2006.09.021
3.
Ben-AmotzO., & SammerD. M. (2015). Practical management of metacarpal fractures. Plastic and Reconstructive Surgery, 136(3), 370e–379e. https://doi.org/10.1097/PRS.0000000000001527
CarvalhoE., BettgerJ. P., & GoodeA. P. (2017). Insurance coverage, costs, and barriers to care for outpatient musculoskeletal therapy and rehabilitation services. North Carolina Medical Journal, 78(5), 312–314. https://doi.org/10.18043/ncm.78.5.312
6.
de PutterC. E., SellesR. W., PolinderS., PannemanM. J. M., HoviusS. E. R., & van BeeckE. F. (2012). Economic impact of hand and wrist injuries: Health-care costs and productivity costs in a population-based study. Journal of Bone and Joint Surgery, 94(9), e56. https://doi.org/10.2106/JBJS.K.00561
FeehanL. M., & BassettK. (2004). Is there evidence for early mobilization following an extraarticular hand fracture? Journal of Hand Therapy, 17(2), 300–308. https://doi.org/10.1197/j.jht.2004.02.014
GülkeJ., LeopoldB., GrözingerD., DrewsB., PaschkeS., & WachterN. J. (2018). Postoperative treatment of metacarpal fractures—Classical physical therapy compared with a home exercise program. Journal of Hand Therapy, 31(1), 20–28. https://doi.org/10.1016/j.jht.2017.02.005
11.
HamiltonW., RoundA., & SharpD. (2002). Patient, hospital, and general practitioner characteristics associated with non-attendance: A cohort study. British Journal of General Practice, 52(477), 317–319.
12.
HardyM. A. (2004). Principles of metacarpal and phalangeal fracture management: A review of rehabilitation concepts. Journal of Orthopaedic and Sports Physical Therapy, 34(12), 781–799. https://doi.org/10.2519/jospt.2004.34.12.781
13.
HarperK., WoodG., SebastienL., & KellenW. (2018). Outcomes of hip and knee total joint arthroplasty in a Canadian inmate population over a 10-year period. Canadian Journal of Surgery, 61(5), 350–354. https://doi.org/10.1503/cjs.015117
14.
HaughtonD., JordanD., MalahiasM., HindochaS., & KhanW. (2012). Principles of hand fracture management. Open Orthopaedics Journal, 6, 43–53. https://doi.org/10.2174/1874325001206010043
15.
KamimuraA., PanahiS., AhmmadZ., PyeM., & AshbyJ. (2018). Transportation and other nonfinancial barriers among uninsured primary care patients. Health Services Research and Managerial Epidemiology, 5, 2333392817749681. https://doi.org/10.1177/2333392817749681
16.
KarlJ. W., OlsonP. R., & RosenwasserM. P. (2015). The epidemiology of upper extremity fractures in the United States, 2009. Journal of Orthopaedic Trauma, 29(8), e242–e244. https://doi.org/10.1097/BOT.0000000000000312
17.
KhanA., & GiddinsG. (2015). The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. Journal of Hand Surgery, 40(1), 59–62. https://doi.org/10.1177/1753193414540408
18.
KollitzK. M., HammertW. C., VedderN. B., & HuangJ. I. (2014). Metacarpal fractures: Treatment and complications. Hand, 9(1), 16–23. https://doi.org/10.1007/s11552-013-9562-1
19.
LabrumJ. T., 4thPaziuk, T., RihnT. C., HilibrandA. S., VaccaroA. R., MaltenfortM. G., & RihnJ. A. (2017). Does Medicaid insurance confer adequate access to adult orthopaedic care in the era of the Patient Protection and Affordable Care Act?. Clinical Orthopaedics and Related Research, 475(6), 1527–1536. https://doi.org/10.1007/s11999-017-5263-3
20.
MalikS., HerronT., & RosenbergN.Fifth metacarpal fractures. [Updated 2022 May 11]. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK470428/ Accessed June3, 2022.
21.
MealsC., & MealsR. (2013). Hand fractures: A review of current treatment strategies. Journal of Hand Surgery, 38(5), 1021–1031. https://doi.org/10.1016/j.jhsa.2013.02.017
22.
MenendezM. E., & RingD. (2015). Factors associated with non-attendance at a hand surgery appointment. Hand, 10(2), 221–226. https://doi.org/10.1007/s11552-014-9685-z
23.
MunnsJ., SamoraJ. B., GrangerJ. F., & NgV. Y. (2013). Caring for the incarcerated: An orthopedic perspective. Orthopedics, 36(12), 904–906. https://doi.org/10.3928/01477447-20131120-02
24.
NakashianM. N., PointerL., OwensB. D., & WolfJ. M. (2012). Incidence of metacarpal fractures in the US population. Hand, 7(4), 426–430. https://doi.org/10.1007/s11552-012-9442-0
25.
PoolmanR. W., GoslingsJ. C., LeeJ. B., Statius MullerM., StellerE. P., & StruijsP. A. A. (2005). Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database of Systematic Reviews, 2005(3), CD003210. https://doi.org/10.1002/14651858.CD003210.pub3
26.
RetrouveyH., MorzyckiA., WangA., Canadian Plastic Surgery ResearchCollaborative, & BinhammerP. (2018). Are we over treating hand fractures? Current practice of single metacarpal fractures. Plastic Surgery, 26(3), 148–153. https://doi.org/10.1177/2292550318767926
27.
SabikL. M., & DahmanB. A. (2012). Trends in care for uninsured adults and disparities in care by insurance status. Medical Care Research and Review, 69(2), 215–230. https://doi.org/10.1177/1077558711418519
28.
SrajS. A. (2016). Providing orthopaedic care for the incarcerated: Obstacles and challenges. Journal of the American Academy of Orthopaedic Surgeons, 24(9), 607–614. https://doi.org/10.5435/JAAOS-D-15-00215
29.
Statius MullerM. G., PoolmanR. W., van HoogstratenM. J., & StellerE. P. (2003). Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: A prospective randomized trial comparing immediate mobilization with cast immobilization. Archives of Orthopaedic and Trauma Surgery, 123(10), 534–537. https://doi.org/10.1007/s00402-003-0580-2
30.
ten BergP. W., & RingD. (2012). Patients lost to follow-up after metacarpal fractures. Journal of Hand Surgery, 37(1), 42–46. https://doi.org/10.1016/j.jhsa.2011.08.003
31.
van AakenJ., FusettiC., LuchinaS., BrunettiS., BeaulieuJ. Y., Gayet-AgeronA., HannaK., ShinA. Y., & HofmeisterE. (2016). Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: Results of a prospective, multicenter, randomized trial. Archives of Orthopaedic and Trauma Surgery, 136(1), 135–142. https://doi.org/10.1007/s00402-015-2361-0
32.
VranisN. M., Ali-KhanS., HuK., DaarD., BruckmanK., & HacquebordJ. (2020). Management and complications of non-thumb metacarpal fractures in the incarcerated population. Journal of Correctional Health Care, 26(2), 151–158. https://doi.org/10.1177/1078345820916240
33.
WallerJ., & HodgkinP. (2000). Defaulters in general practice: Who are they and what can be done about them?. Family Practice, 17(3), 252–253. https://doi.org/10.1093/fampra/17.3.252
34.
WizniaD. H., NwachukuE., RothA., KimC. Y., SaveA., AnandasivamN. S., MedveckyM., & PelkerR. (2017). The influence of medical insurance on patient access to orthopaedic surgery sports medicine appointments under the Affordable Care Act. Orthopaedic Journal of Sports Medicine, 5(7), 2325967117714140. https://doi.org/10.1177/2325967117714140
35.
WongV. W., & HigginsJ. P. (2017). Evidence-based medicine: Management of metacarpal fractures. Plastic and Reconstructive Surgery, 140(1), 140e–151e. https://doi.org/10.1097/PRS.0000000000003470
36.
WorboysT., BrassingtonM., WardE. C., & CornwellP. L. (2018). Delivering occupational therapy hand assessment and treatment sessions via telehealth. Journal of Telemedicine and Telecare, 24(3), 185–192. https://doi.org/10.1177/1357633X17691861
37.
ZongS. L., ZhaoG., SuL. X., LiangW. D., LiL. G., ChengG., WangA. J., CaoX. Q., ZhengQ. T., LiL. D., & KanS. L. (2016). Treatments for the fifth metacarpal neck fractures: A network meta-analysis of randomized controlled trials. Medicine, 95(11), e3059. https://doi.org/10.1097/MD.0000000000003059
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