Metacarpal fractures are among the more common fractures of the upper extremity (1-7), accounting for 18% of all below-elbow fractures in the United States (5). Freehan and Sheps (8) reported that metacarpal fractures represented 42% of 72,481 reviewed cases of hand fractures. Spiral metacarpal fractures commonly result in some shortening of the metacarpal shaft (9), which may subsequently cause extension lag at the metacarpophalangeal (MCP) joint and reduced grip strength (9-13). Several studies have documented the relationship between shortening and hand function (1,9,12,(14)(15)(16)(17)(18)(19)(20)(21), although the maximum amount of shortening that occurs following metacarpal fracture and acceptable limits appear to be controversial.Historically, spiral fractures occurring without scissoring have been treated surgically to restore metacarpal length and prevent these losses in power and function. Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss. Furthermore, one must consider the cost, complications and consequences associated with surgery, postoperative management and wound healing.Increasingly, conservative management of nonscissoring spiral metacarpal fractures has come into favour in the absence of absolute indications for a surgical approach (10,11,16,32). Despite potential shortening of the metacarpal, a nonoperative approach preserves the integrity of the intrinsic muscles of the hand, thereby benefiting functional recovery, while also avoiding the aforementioned consequences and costs of surgery. Unfortunately, however, few studies exist documenting the long-term natural history of unoperated spiral metacarpal fractures. The purpose of the present study was, therefore, to investigate this outcome.We conducted a prospective consecutive case series of unoperated, nonscissoring spiral metacarpal fractures to document the effect of conservative management on resultant power in the hand despite the metacarpal shortening that is often associated with these fractures. BACKgROUND: Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand. OBJECTIVE: To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures. METHODS: Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural histor...

Metacarpal fractures are among the more common fractures of the upper extremity (1-7), accounting for 18% of all below-elbow fractures in the United States (5). Freehan and Sheps (8) reported that metacarpal fractures represented 42% of 72,481 reviewed cases of hand fractures. Spiral metacarpal fractures commonly result in some shortening of the metacarpal shaft (9), which may subsequently cause extension lag at the metacarpophalangeal (MCP) joint and reduced grip strength (9-13). Several studies have documented the relationship between shortening and hand function (1,9,12,(14)(15)(16)(17)(18)(19)(20)(21), although the maximum amount of shortening that occurs following metacarpal fracture and acceptable limits appear to be controversial.Historically, spiral fractures occurring without scissoring have been treated surgically to restore metacarpal length and prevent these losses in power and function. Although previous studies have demonstrated beneficial outcomes in hand function following operative treatment of spiral metacarpal fractures (5,18,(22)(23)(24)(25)(26)(27)(28), surgical management is not without consequences and complications (27-31). Stripping of the interossei, which power MCP flexion from the underlying bone for internal fixation, for example, may also lead to power loss. Furthermore, one must consider the cost, complications and consequences associated with surgery, postoperative management and wound healing.Increasingly, conservative management of nonscissoring spiral metacarpal fractures has come into favour in the absence of absolute indications for a surgical approach (10,11,16,32). Despite potential shortening of the metacarpal, a nonoperative approach preserves the integrity of the intrinsic muscles of the hand, thereby benefiting functional recovery, while also avoiding the aforementioned consequences and costs of surgery. Unfortunately, however, few studies exist documenting the long-term natural history of unoperated spiral metacarpal fractures. The purpose of the present study was, therefore, to investigate this outcome.We conducted a prospective consecutive case series of unoperated, nonscissoring spiral metacarpal fractures to document the effect of conservative management on resultant power in the hand despite the metacarpal shortening that is often associated with these fractures. BACKgROUND: Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand. OBJECTIVE: To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures. METHODS: Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural histor...