Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures

Abstract

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...

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

“…Shaft fractures of second to fourth metacarpals were managed with certain similarities, such as spiral fractures, receiving forearmbased wrist splints. 15,16 Active mobilisation was suggested for spiral fractures, but intra-and extra-articular fractures were conservatively or surgically managed with forearm-based thermoplastic splints with a dorsal hood piece left for three weeks with the splint being removed from four weeks. 14,23 Wrist POP for two weeks was also suggested for spiral and long oblique fractures.…”

“…In Nova Scotia, a prospective research study was conducted on 61 patients with second to fifth non-scissoring spiral metacarpal fractures where they were managed conservatively. 16 A low GRADE quality of evidence rating was given. Exclusion criteria included metacarpal fractures requiring surgical intervention and thumb fractures.…”

“…At five months, the final follow-up, the mean grip strength for the uninjured hand was 36.18 kg and the injured hand 36.58 kg. 16 From these three studies, the following splint can be used with confidence for individuals who sustained second to fifth metacarpal shaft fractures: • Thermoplastic splint with the wrist in 20-30° with the fingers free.…”

Protocol for surgical and non-surgical treatment for metacarpal shaft fractures in adults: an observational feasibility study

“…This was supported by previous studies of MSF reporting full range of motion in almost all patients by 6 months. 17 Furthermore, previous studies in similar patient cohorts with follow-up of 12 months or longer suffered high drop-rates or struggled to recruit adequate numbers of participants. A participant pathway flowchart is illustrated in figure 1 .…”

Effect of a figure-of-eight cerclage wire with two Kirschner wires on fixation strength for transverse metacarpal shaft fractures: an in vitro study with artificial bone

“…Variations in injury mechanisms can lead to different types of metacarpal shaft fractures, such as transverse, oblique, spiral, or comminuted fractures. Conservative treatment with cast immobilization is only applicable to stable fractures in which the fractured bone is not displaced [ 4 , 5 ]. Otherwise, surgical fixation is required.…”