Treatment of non-articular metacarpal fractures excluding thumb
Systematic bibliographic review
Keywords:
METACARPAL BONES, BONE FRACTURESAbstract
Metacarpal fractures constitute 10% of the total number of fractures(1) and they represent 30%-50% of hand fractures(2). Fracture of the fifth metacarpal neck is the most frequent one, also called Boxer fracture, corresponding to 20% of all hand fractures. Literature favors a conservative treatment for most of these fractures, since they are stable from the beginning or after a closed reduction. Our bibliographic review aims to define the different criteria used to treat extra-articular metacarpal fractures excluding the thumb, with or without surgery. To that end, we conducted a systematized review of the last 10 years in patients over 18 years old, obtaining 19 articles that met our inclusion criteria. Our analysis strategy was to review therapy indications, frequency and justification. Systematized revision was divided into three groups of work: those who dealt with orthopedic treatment, those who indicated surgical treatment and those who compared results between the two treatments. Results led to the conclusion that there is no surgical indication that is universally recommended, since literature lacks Level I or II studies on this matter. Our review reveals the most frequently accepted surgical indications in literature. Dorsal angulation exceeding 30 degrees, malrotation and shortening stand out, all of which result in severe sequelae such as crossfinger, loss of extension or grip strength. Last, there being no consensus and until there is enough scientific evidence, decisions on therapeutic strategies are to the orthopedic surgeon, which decision shall be based on their experience, considering the kind of fracture, materials available and reviewed literature that supports it.
References
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(2) Court-Brown CM. The epidemiology of fractures. En: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P. Rockwood and Green’s fractures in adults. 7 ed. Philadelphia: Lippincott Williams & Wilkins, 2010: cap. 3.
(3) Emmett JE, Breck LW. A review of analysis of 11,000 fractures seen in a private practice of orthopaedic surgery 1937-1956. J Bone Joint Surg Am 1958; 40-A(5):1169–75.
(4) Amadio PC. Fractures of the hand and the wrist. En: Jupiter JB, ed. Flynn’s hand surgery. Baltimore: Williams & Wilkins, 1991:122-85.
(5) Barton NJ. Fractures of the hand. J Bone Joint Surg Br 1984; 66(2):159-67.
(6) Sahu A, Gujral SS, Batra S, Mills SP, Srinivasan MS. The current practice of the management of little finger metacarpal fractures: a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg 2012; 17(1):55-63.
(7) Geissler WB. Operative fixation of metacarpal and phalangeal fractures in athletes. Hand Clin 2009; 25(3):409-21.
(8) Haughton DN, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture. Open Orthop J 2012, 6(Suppl 1):43-53.
(9) Margi K. External fixation of closed metacarpal and phalangeal fractures of digits. A prospective study of one hundred consecutive patients. J Hand Surg Br 2006; 31(1):30-40.
(10) Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg 2008; 16(10):586-95.
(11) Strauch RJ, Rosenwasser MP, Lunt JG. Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am 1998; 23(3):519-23.
(12) Simon H, Chin SM, Vedder NB. MOC-PS(SM) CME Article: metacarpal fractures. Plast Reconstr Surg 2008; 121(Suppl 1):1-13.
(13) Han SH, Rhee SY, Lee SC, Han SC, Cha YS. Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger. Eur J Orthop Surg Traumatol 2013; 23(8):883-7.
(14) Opgrande JD, Westphal SA. Fractures of the hand. Orthop Clin North Am 1983; 14(4):779-92.
(15) Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29(4):689-93.
(16) Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 1999; 24(4):835-44.
(17) Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 2006; 22(3):287-95.
(18) Eglseder WA Jr, Juliano PJ, Roure R. Fractures of the fourth metacarpal. J Orthop Trauma 1997; 11(6):441-5.
(19) Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23(1):19-33.
(20) de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals: a retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury 1994; 25(6):365-9.
(21) Freeland AE, Jabaley ME, Hughes JL. Oblique and spiral metacarpal shaft fractures. En: Freeland AE, Jabaley ME, Hughes JL. Stable fixation of the hand and wrist. New York: Springer-Verlag, 1986:55–7.
(22) Wright TA. Early mobilization in fractures of the metacarpals and phalanges. Can J Surg 1968; 11(4):491-8.
(23) Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 1997; 99(4):1079-83
(24) González MH, Bach HG, Elhassan BT, Graf CN, Weinzweig N. Management of open hand fractures. J Am Soc Surg Hand 2003; 3(4):208-18.
(25) Haughton D, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture management. Open Orthop J 2012; 6:43-53.
(26) Büchler U, Gupta A, Ruf S. Corrective osteotomy for post-traumatic malunion of the phalanges in the hand. J Hand Surg Br 1996; 21(1):33-42.
(27) Thomas D. Métacarpiens traumatiques. EMC Kinésithér Méd Phys Réadap 2008; 26-220-B-11.
(28) Swanson AB. Fractures involving the digits of the hand. Orthop Clin North Am 1970; 1(2):261-74.
(29) Chen SH, Wei FC, Chen HC, Chuang CC, Noordhoff S. Miniature plates and screws in acute complex hand injury. J Trauma 1994; 37(2):237-42.
(30) Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78(3):285-92.
(31) Friedrich B, Klaue P. Mechanical stability and post-traumatic osteitis: an experimental evaluation of the relation between infection of bone and internal fixation. Injury 1977; 9(1):23-9.
(32) Swanson A. Fractures involving the digits of the hand Orthop Clinic North Am 1970;37:237–242.
(33) Godina M. Early microsurgical reconstruction of complex trauma of the extremities.
(34) Stahl S, Lerner A, Kaufman T. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. Case reports. Scand J Plast Reconstr Surg Hand Surg 1999; 33(1):117-22.
(35) Westbrook AP, Davis TR, Armstrong D, Burke FD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol 2008; 33(6):732-9.
(36) Al-Qattan MM. Outcome of conservative management of spiral/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilisation of the fingers. J Hand Surg Eur Vol 2008; 33(6):723-7.
(37) Tavassoli J, Ruland RT, Hogan CJ, Cannon DL. Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments. J Bone Joint Surg Am 2005; 87(10):2196-201.
(38) Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005; (3):CD003210.
(39) Debnath UK, Nassab RS, Oni JA, Davis TR. A prospective study of the treatment of fractures of the little finger metacarpal shaft with a short hand cast. J Hand Surg Br 2004; 29(3):214-7.
(40) Kanatli U, Kazimo?lu C, U?urlu M, Esen E. Evaluation of functional results in conservatively treated boxer’s fractures. Acta Orthop Traumatol Turc 2002; 36(5):429-31.
(41) Kanatli U, Kazimoglu C, Ugurlu M, Esen E. Evaluation of functional results in conservatively treated boxer’s fractures.Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 1999; 24(4):835-44.
(42) Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in managing fractures of metacarpal and phalangess. Indian J Plast Surg 2011; 44(2):203-11.
(2) Court-Brown CM. The epidemiology of fractures. En: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P. Rockwood and Green’s fractures in adults. 7 ed. Philadelphia: Lippincott Williams & Wilkins, 2010: cap. 3.
(3) Emmett JE, Breck LW. A review of analysis of 11,000 fractures seen in a private practice of orthopaedic surgery 1937-1956. J Bone Joint Surg Am 1958; 40-A(5):1169–75.
(4) Amadio PC. Fractures of the hand and the wrist. En: Jupiter JB, ed. Flynn’s hand surgery. Baltimore: Williams & Wilkins, 1991:122-85.
(5) Barton NJ. Fractures of the hand. J Bone Joint Surg Br 1984; 66(2):159-67.
(6) Sahu A, Gujral SS, Batra S, Mills SP, Srinivasan MS. The current practice of the management of little finger metacarpal fractures: a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg 2012; 17(1):55-63.
(7) Geissler WB. Operative fixation of metacarpal and phalangeal fractures in athletes. Hand Clin 2009; 25(3):409-21.
(8) Haughton DN, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture. Open Orthop J 2012, 6(Suppl 1):43-53.
(9) Margi K. External fixation of closed metacarpal and phalangeal fractures of digits. A prospective study of one hundred consecutive patients. J Hand Surg Br 2006; 31(1):30-40.
(10) Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg 2008; 16(10):586-95.
(11) Strauch RJ, Rosenwasser MP, Lunt JG. Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am 1998; 23(3):519-23.
(12) Simon H, Chin SM, Vedder NB. MOC-PS(SM) CME Article: metacarpal fractures. Plast Reconstr Surg 2008; 121(Suppl 1):1-13.
(13) Han SH, Rhee SY, Lee SC, Han SC, Cha YS. Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger. Eur J Orthop Surg Traumatol 2013; 23(8):883-7.
(14) Opgrande JD, Westphal SA. Fractures of the hand. Orthop Clin North Am 1983; 14(4):779-92.
(15) Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29(4):689-93.
(16) Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 1999; 24(4):835-44.
(17) Kawamura K, Chung KC. Fixation choices for closed simple unstable oblique phalangeal and metacarpal fractures. Hand Clin 2006; 22(3):287-95.
(18) Eglseder WA Jr, Juliano PJ, Roure R. Fractures of the fourth metacarpal. J Orthop Trauma 1997; 11(6):441-5.
(19) Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23(1):19-33.
(20) de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals: a retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury 1994; 25(6):365-9.
(21) Freeland AE, Jabaley ME, Hughes JL. Oblique and spiral metacarpal shaft fractures. En: Freeland AE, Jabaley ME, Hughes JL. Stable fixation of the hand and wrist. New York: Springer-Verlag, 1986:55–7.
(22) Wright TA. Early mobilization in fractures of the metacarpals and phalanges. Can J Surg 1968; 11(4):491-8.
(23) Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 1997; 99(4):1079-83
(24) González MH, Bach HG, Elhassan BT, Graf CN, Weinzweig N. Management of open hand fractures. J Am Soc Surg Hand 2003; 3(4):208-18.
(25) Haughton D, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture management. Open Orthop J 2012; 6:43-53.
(26) Büchler U, Gupta A, Ruf S. Corrective osteotomy for post-traumatic malunion of the phalanges in the hand. J Hand Surg Br 1996; 21(1):33-42.
(27) Thomas D. Métacarpiens traumatiques. EMC Kinésithér Méd Phys Réadap 2008; 26-220-B-11.
(28) Swanson AB. Fractures involving the digits of the hand. Orthop Clin North Am 1970; 1(2):261-74.
(29) Chen SH, Wei FC, Chen HC, Chuang CC, Noordhoff S. Miniature plates and screws in acute complex hand injury. J Trauma 1994; 37(2):237-42.
(30) Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78(3):285-92.
(31) Friedrich B, Klaue P. Mechanical stability and post-traumatic osteitis: an experimental evaluation of the relation between infection of bone and internal fixation. Injury 1977; 9(1):23-9.
(32) Swanson A. Fractures involving the digits of the hand Orthop Clinic North Am 1970;37:237–242.
(33) Godina M. Early microsurgical reconstruction of complex trauma of the extremities.
(34) Stahl S, Lerner A, Kaufman T. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. Case reports. Scand J Plast Reconstr Surg Hand Surg 1999; 33(1):117-22.
(35) Westbrook AP, Davis TR, Armstrong D, Burke FD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol 2008; 33(6):732-9.
(36) Al-Qattan MM. Outcome of conservative management of spiral/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilisation of the fingers. J Hand Surg Eur Vol 2008; 33(6):723-7.
(37) Tavassoli J, Ruland RT, Hogan CJ, Cannon DL. Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments. J Bone Joint Surg Am 2005; 87(10):2196-201.
(38) Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005; (3):CD003210.
(39) Debnath UK, Nassab RS, Oni JA, Davis TR. A prospective study of the treatment of fractures of the little finger metacarpal shaft with a short hand cast. J Hand Surg Br 2004; 29(3):214-7.
(40) Kanatli U, Kazimo?lu C, U?urlu M, Esen E. Evaluation of functional results in conservatively treated boxer’s fractures. Acta Orthop Traumatol Turc 2002; 36(5):429-31.
(41) Kanatli U, Kazimoglu C, Ugurlu M, Esen E. Evaluation of functional results in conservatively treated boxer’s fractures.Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 1999; 24(4):835-44.
(42) Kamath JB, Harshvardhan, Naik DM, Bansal A. Current concepts in managing fractures of metacarpal and phalangess. Indian J Plast Surg 2011; 44(2):203-11.
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Published
2016-09-30
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Del Castillo J, Casales N, Filomeno P. Treatment of non-articular metacarpal fractures excluding thumb: Systematic bibliographic review. Rev. Méd. Urug. [Internet]. 2016 Sep. 30 [cited 2024 Sep. 7];32(3):205-17. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/169
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