Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec;10(4):607-12.
doi: 10.1007/s11552-015-9749-8. Epub 2015 Feb 18.

Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures

David Gamble  1 , Paul J Jenkins  1 , Martyn J Edge  1 , Alisdair Gilmour  1 , Iain C Anthony  1 , Margaret Nugent  1 , Lech A Rymaszewski  1
Affiliations

Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures

David Gamble et al. Hand (N Y). 2015 Dec.

Abstract

Background: Fifth metacarpal fractures are common and comprise a significant proportion of traditional orthopaedic fracture clinic workload. We reviewed the functional outcome and the satisfaction of patients managed with a new protocol that promoted "self-care" and resulted in the discharge of most of these patients from the emergency department with no further follow-up.

Methods: A retrospective study was performed of patients discharged with a fifth metacarpal fracture between April 2012 to October 2012. A postal questionnaire was sent to each patient, followed by a telephone call. Patient-reported outcome measures (EQ-5D, QuickDASH) and patient satisfaction were assessed. Of the 167 patients eligible for the study, 5 were excluded. Of the remaining 162, 64 were uncontactable or declined to participate. The mean follow-up time was 21.6 months (SD 1.9, range 18.1 to 24.7).

Results: The median EQ-5D health index score was 0.87 (IQR 0.74 to 1.00), and the median QuickDASH score was 2.3 (IQR 0 to 6.8). Seventy-nine (80.6 %) patients were satisfied with the outcome of their injury, while 83 (84.9 %) reported being satisfied with the process. There was no difference between those with a fracture or those without a fracture in EQ-5D (p = 0.307) or QuickDASH (p = 0.820).

Conclusion: Fifth metacarpal fractures can be managed effectively through an Emergency Department protocol without any formal orthopaedic follow-up. This pathway lead to excellent patient-reported outcome measures and patient satisfaction. This protocol has reduced unnecessary hospital attendances for patients and increased the time available for clinicians to deal with more challenging injuries.

Keywords: Fracture; Fracture clinic redesign; Metacarpal; Virtual fracture clinic.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart of study group
Fig. 2
Fig. 2
Overall satisfaction with clinical outcome (%)
Fig. 3
Fig. 3
Histogram of individual EQ-5D domain scores (1 best score, 5 worst score)
See this image and copyright information in PMC

References

    1. Arafa M, Haines J, Noble J, et al. Immediate mobilization of fractures of the neck of the fifth metacarpal. Injury. 1986;17:277–88. doi: 10.1016/0020-1383(86)90237-8. - DOI - PubMed
    1. Bansal R, Craigen MA. Fifth metacarpal neck fractures: is follow-up required? J Hand Surg Br. 2007;32:69–7. doi: 10.1016/j.jhsb.2006.09.021. - DOI - PubMed
    1. Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–46. doi: 10.2106/JBJS.D.02060. - DOI - PubMed
    1. Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998;29:5–9. doi: 10.1016/S0020-1383(97)00106-X. - DOI - PubMed
    1. Breddam M, Hansen TB. Subcapital fractures of the fourth and fifth metacarpals treated without splinting and reposition. Scand J Plast Reconstr Surg Hand Surg. 1995;29:269–70. doi: 10.3109/02844319509050138. - DOI - PubMed

LinkOut - more resources