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. 2024 Aug 8;5(8):652-661.
doi: 10.1302/2633-1462.58.BJO-2024-0064.

Management of metacarpal shaft fractures

Rowa Taha  1 , Tim Davis  2 , Alan Montgomery  3 , Alexia Karantana  1   2   3 ; Metacarpal Shaft Fracture Group; Luke Allen  4   5   6   7   8 , Rouin Amirfeyz  4   5   6   7   8 , Kaneka Bernard  4   5   6   7   8 , Grainne Bourke  4   5   6   7   8 , Tim Davis  4   5   6   7   8 , Anthony Egglestone  4   5   6   7   8 , Soham Gangopadhyay  4   5   6   7   8 , Nicholas Kerr  4   5   6   7   8 , Gregory Pickering  4   5   6   7   8 , Rebecca Shirley  4   5   6   7   8 , Julia Street  4   5   6   7   8 , Ryan Trickett  4   5   6   7   8 , Knishka Vora  4   5   6   7   8 , Ryckie G Wade  4   5   6   7   8 , Justin Wormald  4   5   6   7   8 , Tim R Davis  4   5   6   7   8 , Alexia Karantana  4   5   6   7   8 , Alan Montgomery  4   5   6   7   8 , Rowa Taha  4   5   6   7   8
Affiliations

Management of metacarpal shaft fractures

Rowa Taha et al. Bone Jt Open. .

Abstract

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality.

Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence.

Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments.

Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment.

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Conflict of interest statement

The British Society for Surgery of the Hand provided funding for the development of research into hand surgery, which covered R. Taha's salary and her costs while working on this study as part of her PhD. R. Taha's doctoral research fellowship was also funded by the National Institute for Health and Care Research (grant number NIHR300197). R. Taha is also on the BSSH's LION Project Leadership Committee. A. Karantana and A. Montgomery report payments to the University of Nottingham from the NIHR towards this study, as well as various contracts for other research. A. Karantana also reports an infrastructure grant from the British Orthopaedic Association to the Nottingham Clinical Trials Unit to support the development of orthopaedic trials, and holds unpaid positions as Chair of the BSSH Research Committee, BOA Subspecialty Research Lead for Hand Surgery, and Research Council member of the Scar Free Foundation.

Figures

Fig. 1
Fig. 1
Monthly distribution of metacarpal shaft fractures across centres. MSF, metacarpal shaft fracture.
See this image and copyright information in PMC

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