Asian Journal of Plastic and Reconstructive Surgery > Uncategorized > Non-surgical management of Metacarpal Bone fractures in Army Hospital Sri Lanka

Non-surgical management of Metacarpal Bone fractures in Army Hospital Sri Lanka

I Wickramarachchi1, TMS Sandamali1, MA Wickramaratne1, GK Rajapakse1.

Author Information

1 Department of Plastic and Reconstructive Surgery, Army Hospital, Colombo 5, Sri Lanka

#For correspondence: [email protected]

Abstract

Metacarpal fractures comprise between 18–44% of all hand fractures. Metacarpals except thumb account for around 88% of all metacarpal fractures, with the little finger most commonly involved. The majority of metacarpal fractures are isolated injuries, which are simple, closed, and stable. While many metacarpal fractures do well non-surgically, there is a lack of literature and persistent controversy to guide the managing surgeon on the best treatment option.

A retrospective observational study was conducted at the Army Hospital from 2023 January to 2024 January assessing 45 patients. They were aged between 20-60 years and presented with metacarpal bone shaft fractures except the thumb considering acceptable angulation, shortening and minimal rotation in fractures. They were managed non-surgically with ulnar gutter and radial gutter splints with buddy strapping for minimally up to 6 weeks. They were followed up to 6 weeks minimally.

These patients were reviewed in 2 weeks and 6 weeks with follow-up x-rays and the clinical condition was assessed. As a general principle, early mobilization should be considered when deciding the method of splinting.

In conclusion out of the 45 patients we analysed majority were male, and the mean age was 24.6 years. The most common mechanism of injury was accidental falls (28 patients, 62%). Immediately after splint removal, 90% had a full range of finger movement and 90% were pain-free. Few required occupational therapy. Five patients experienced minor complications, non-limiting extensor lag and minimal residual pain. Non-surgical management with a thermoplastic splint and buddy strapping is an effective, economical treatment for metacarpal fractures.

Article

Declarations
None

Ethics approval and consent to participate
Not applicable

Consent for publication
Informed written consent for publication and accompanying images was obtained from the patients prior to collecting information.

Availability of data and material
All data generated or analyzed during this study are included in this published article

Competing interests
The authors declare that they have no competing interests.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

References

  1. Al-Qattan M. Outcome of conservative management of spira/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilization of the fingers. J Hand Surg Eur. 2008, 33: 723-7

  2. Anakwe RE, Aitken SA, Cowie JG, Middleton SD, Court-Brown CM. The epidemiology of fractures of the hand and the influence of social deprivation. J Hand Surg Eur., 2011, 36: 62-5. Debnath UK, Nassab RS, Oni JA, Davis TRC. A prospective study of the treatment of fractures of the little finger metacarpal shaft with a short hand cast. J Hand Surg Eur. 2004, 29: 214-7. Giddins GEB. The non-operative management of hand fractures. J Hand Surg Eur. 2015, 40: 33-41.

  3. Harding lJ, Parry D, Barrington RL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg Eur. 2001, 26: 261-3. Harris AR, Beckenbaugh RD, Nettrour JF, Rizzo M. Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand (NY). 2009, 4: 161-4.

  4. HaughtOf hand DN, Jordan D, Malahias M, Hindocha S, Khan W. Principles of fracture management. Open Orthop J. 2012, 6: 43-53

  5. Khan A, Giddins G. The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. J Hand Surg Eur. 2015, 40: 59-62.

  6. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand [NY). 2014, 9: 16-23.

  7. Konradsen L, Nielsen PT, Albrecht-Beste E. Functional treatment of metacarpal fractures: 100 randomized cases with or without fixation. Acta Orthop Scand. 1990, 61: 531-4.

  8. Richards T, Clement R, Russell I, Newington N. Acute hand injury splinting – the good, the bad and the ugly. Ann R Coll Surg Engl.2018, 100: 92-6.

  9. Strub B, Schindele S, Sonderegger J, Sproedt J. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur. 2010, 35: 725-9.

  10. Tang JN, Giddins G. Why and how to report surgeons levels of expertise. J Hand Surg Eur. 2016, 41: 365-6.

  11. 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 alignment. J Bone Joint Surg Am. 2005, 87: 196-201.

  12. Tawa R. Fractures of adult metacarpal shafts (FACTS) study. 2020. jects/hand-wrist-fracturee/estCn/groups/cebhs/pro https://www.nottingham.ac.uk/ry.aspx laccessed 13 May 2021).

  13. Wong VW, Higgins JP. Evidence-based medicine: management of metacarpal fractures. Plast Reconstr Surg. 2017, 140: 140-51.