Evaluation of an evidence-based patient pathway for non-surgical and surgically managed metacarpal fractures

Abstract

Introduction

A review of current literature was used to develop an evidence-based pathway, managing surgical and non-surgical metacarpal fractures according to their anatomical location and fracture stability. The aim of this paper is to evaluate functional outcome, splint compliance, range of motion (ROM), residual pain, return to work and patient satisfaction following treatment based on the pathway.

Method

Fifty patients referred for surgical or non-surgical management of metacarpal fracture(s) were selected to participate in the clinical evaluation. Patient demographics, fracture site, management approach, type of splint, number of appointments attended and complications were recorded. A telephone questionnaire was used to evaluate patient satisfaction, compliance with splinting, ROM, pain, return to work and functional outcome. Recorded complications included infection, malunion, nonunion, rotational deformity and angulation deformity.

Results

Thirty-six patients were contactable 10–24 weeks post-injury. A total of 23 metacarpal neck/head, eight shaft and four base fractures were included. Ninety-four percent (34/36) of fractures were treated non-operatively. Patients were compliant with splinting in 17/36 (47%) cases. There were no reported complications. Seventy-two percent reported no pain at follow-up. All employed patients returned to work. Full ROM was reported in all cases. Full functional use of the hand was present in 92% of cases. Patients reported high satisfaction with the service (8/10) and required an average of three therapy appointments.

Conclusion

The metacarpal fracture evidence-based pathway was successful with 92% of patients returning to full function. The absence of complications emphasizes hand therapy's ability to efficiently and cost-effectively manage these fractures following referral. The pathway has been further refined as a result of the clinical evaluation, with alteration of the metacarpal shaft fracture splint, removal of repeat X-rays and reduction of splinting durations. It is recommended that the revised pathway is further evaluated.