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Comparative Study
. 2025 Jan 2;36(1):182-192.
doi: 10.52312/jdrs.2025.1983. Epub 2024 Dec 18.

Is casting superior to plate fixation in metacarpal shaft fractures?

Orhun Eray Bozkurt  1 , Ugur Bezirgan, Erdinc Acar, Osman Talha Nergizal, Ebru Dumlupinar, Mehmet Armangil
Affiliations
Comparative Study

Is casting superior to plate fixation in metacarpal shaft fractures?

Orhun Eray Bozkurt et al. Jt Dis Relat Surg. .

Abstract

Objectives: This study aimed to compare the outcomes and conduct a cost analysis between plate screw fixation and conservative treatment.

Patients and methods: The retrospective study was conducted with 36 patients (32 males, 4 females; mean age: 30.3±13.4 years; range, 16 to 65 years) between May 2019 and July 2023. The patients were divided into two groups: those who underwent surgery with miniplate fixation (n=21) and those who were conservatively managed (n=15). The differences in postoperative shortening and angulation were compared between these groups. Additionally, the patients' postoperative functional scores, complication rates, examination findings, and cost analyses were compared.

Results: The per-patient cost in the surgical group was higher than in the conservatively treated group (€246.96 vs. €45.07; p<0.001). While postoperative shortening and angulation were more pronounced in the nonoperative group, the other clinical parameters and functional scores were improved. The return-to-work time was longer in the nonoperative group due to prolonged immobilization.

Conclusion: Nonoperative splint treatment for metacarpal shaft fractures shows better radiological and clinical outcomes than surgery, except for angulation and shortening, which have limited impact on function. Due to higher costs in surgical cases, nonoperative treatment is more cost-effective. Larger, randomized trials are needed to confirm these findings.

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Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. The flowchart of patients included in the study.
Figure 2
Figure 2. Intrinsic plus splint application used in conservatively managed metacarpal shaft fractures.
Figure 3
Figure 3. The preoperative radiograph of the metacarpal shaft fracture treated surgically.
Figure 4
Figure 4. The postoperative radiograph of the metacarpal shaft fracture treated surgically at the third week.
Figure 5
Figure 5. Angular measurement in an oblique radiograph.
Figure 6
Figure 6. Measurement of shortening on anteroposterior radiographs. The length measurement of the unaffected fifth metacarpal bone (left hand) is shown on the left side. The length measurement of the fifth metacarpal bone (right hand), which healed following a shaft fracture, is demonstrated on the right side. The difference in length (a-b) between the two was calcuted.
Figure 7
Figure 7. The pretreatment radiograph of the metacarpal shaft fracture treated conservatively.
Figure 8
Figure 8. The posttreatment one-year radiograph of the metacarpal shaft fracture treated conservatively.
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