Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients
Restricted accessResearch articleFirst published online January, 2015
Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients
Current literature gives few guidelines regarding indication for operative treatment of little finger metacarpal neck fractures, and some surgeons choose operative treatment when the palmar angulation exceeds 30°. The objective of this study was to determine whether conservative treatment produces comparable outcomes with bouquet pinning in a randomized, controlled trial. Eighty-five patients with little finger metacarpal neck fractures with ≥30° palmar angulation in the lateral view were included. Patients were randomized to two groups: conservative treatment without reduction of the fracture (43 patients); and closed reduction and bouquet pinning (42 patients). After 1 year, there were no statistical differences between the groups in QuickDASH score, pain, satisfaction, finger range of motion, grip strength, or quality of life. There was a trend versus better satisfaction with hand appearance (p = 0.06), but longer sick leave (p < 0.001) and more complications (p = 0.02) in the operative group.
AliAHammanJMassDP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am. 1999, 24: 835–44.
2.
ArafaMHainesJNobleJCardenD. Immediate mobilization of fractures of the neck of the fifth metacarpal. Injury. 1986, 17: 277–8.
3.
BeatonDEWrightJGKatzJN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005, 87: 1038–46.
4.
BirndorfMSDaleyRGreenwaldDP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg. 1997, 99: 1079–83; discussion 84–5.
5.
BreddamMHansenTB. Subcapital fractures of the fourth and fifth metacarpals treated without splinting and reposition. Scand J Plast Reconstr Surg Hand Surg. 1995, 29: 269–70.
6.
BraakmanMOderwaldEEHaentjensMH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998, 29: 5–9.
7.
CalvertMBlazebyJAltmanDGRevickiDAMoherDBrundageMD. Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013, 309: 814–22.
8.
Del PinalF. I have a dream … reflex sympathetic dystrophy (RSD or Complex Regional Pain Syndrome – CRPS I) does not exist. J Hand Surg Eur. 2013, 38: 595–7.
9.
EuroQolGroup. EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990, 16: 199–208.
10.
FoucherG. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995, 20: S86–90.
11.
FrereGHoelGMoutetFRavetD. Fractures of the fifth metacarpal neck. Ann Chir Main. 1982, 1: 221–6.
12.
GiddinsG. The non-operative treatment of hand fractures. J Hand Surg Eur. 2015, 40: 33–41.
13.
GreerSEWilliamsJM. Boxer’s fracture: an indicator of intentional and recurrent injury. Am J Emerg Med. 1999, 17: 357–60.
14.
GudmundsenTEBorgenL. Fractures of the fifth metacarpal. Acta Radiol. 2009, 50: 296–300.
15.
HansenPBHansenTB. The treatment of fractures of the ring and little metacarpal necks. A prospective randomized study of three different types of treatment. J Hand Surg Br. 1998, 23: 245–7.
16.
HardenRNBruehlSStanton-HicksMWilsonPR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007, 8: 326–31.
17.
HardingIJParryDBarringtonRL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg Br. 2001, 26: 261–3.
18.
HargreavesDGDrewSJEckersleyR. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. J Hand Surg Br. 2004, 29: 374–6.
19.
HoveLM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg. 1993, 27: 317–9.
KennedyCBeatonDESolwaySMcConnellSBombardierC. The DASH and QuickDASH Outcome measure user’s manual. 3rd Edn.Toronto, Ontario, Institute for Work & Health, 2011.
22.
KuokkanenHOMulari-KeranenSKNiskanenROHaapalaJKKorkalaOL. Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg. 1999, 33: 315–7.
23.
LamraskiGMonsaertADe MaeseneerMHaentjensP. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res. 2006, 24: 37–45.
24.
ManuedduCADella SantaD. Fasciculated intramedullary pinning of metacarpal fractures. J Hand Surg Br. 1996, 21: 230–6.
25.
MarshJLSlongoTFAgelJ. Fracture and dislocation classification compendium − 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007, 21: S1–133.
26.
McKerrellJBowenVJohnstonGZondervanJ. Boxer’s fractures—conservative or operative management?J Trauma. 1987, 27: 486–90.
27.
PackerGJShaheenMA. Patterns of hand fractures and dislocations in a district general hospital. J Hand Surg Br. 1993, 18: 511–4.
28.
PageSMSternPJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998, 23: 827–32.
29.
PiaggioGElbourneDRPocockSJEvansSJAltmanDG. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012, 308: 2594–604.
RabinROemarMOppeM, Office EGE, Group ObotE. EQ-5D-3L user guide. Basic information on how to use the EQ-5D-3L instrument.Version 4.0, EuroQol Group 2011, 2011.
32.
Schadel-HopfnerMWildMWindolfJLinhartW. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal?Arch Orthop Trauma Surg. 2007, 127: 435–40.
33.
SlettenINNordslettenLHjorthaugGAHellundJCHolmeIKvernmoHD. Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur. 2012a, 38: 658–66.
34.
SlettenINNordslettenLHusbyTOdegaardRAHellundJCKvernmoHD. Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. J Hand Surg Eur. 2012b, 37: 387–95.
35.
StantonJSDiasJJBurkeFD. Fractures of the tubular bones of the hand. J Hand Surg Eur. 2007, 32: 626–36.
36.
StrubBSchindeleSSondereggerJSproedtJvon CampeAGruenertJG. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur. 2010, 35: 725–9.
37.
TangJB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur. 2009, 34: 137–8.
38.
ViegasSFTencerAWoodardPWilliamsCR. Functional bracing of fractures of the second through fifth metacarpals. J Hand Surg Am. 1987, 12: 139–43.
39.
WestbrookAPDavisTRArmstrongDBurkeFD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur. 2008, 33: 732–9.
40.
WinterMBalaguerTBessiereCCarlesMLebretonE. Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur. 2007, 32: 709–13.
