Management and Complications of Non-Thumb Metacarpal Fractures in the Incarcerated Population

Abstract

We reviewed the patient demographics, injury mechanisms, fracture characteristics, treatment modalities, and outcomes of incarcerated patients who were referred for metacarpal fracture evaluation and treatment to our high-volume tertiary care center from a New York City Department of Correction infirmary facility. There is a scarcity of information in the orthopedic and plastic surgery literature on treating these common fractures in this vulnerable population. We conducted a basic statistical analysis and discuss the potential implications of these findings. We found a high incidence of stiffness that may relate to the high rates of follow-up noncompliance coupled with prolonged immobilization. Awareness of these findings may influence treating hand specialists to use less restrictive immobilization devices such as functional bracing, elastic bandage, or neighbor strapping as an effort to promote bony union without the risk of developing stiffness and the potential to compromise general hand function when treating non-thumb metacarpal fractures.

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research

“…Among the 12 studies with IRB approval, 6 included a waiver of consent, 13 , 20 – 24 while 6 did not report the status of consent waivers. 25 – 30 Four studies identified incarcerated patients through International Classification of Diseases (ICD) codes: Y92:14 X (prion as location of injury) or E849.7 (injury occurring in residential institution), 17 , 18 , 21 , 23 4 used admission or discharge locations, 16 , 23 , 27 , 28 8 used prison referral or electronic medical record review, 13 , 19 , 22 , 24 – 26 , 29 , 30 1 used prison billing data, 15 and 1 used prospective identification during consultation. 20 Using the ROBINS-E tool risk of bias assessment, 70.6% of the studies had high or very high concerns for bias (Fig.…”

“…Twelve studies reported on nonelective surgeries: 1 on emergency general surgery, 16 8 on trauma, 15 , 17 , 19 , 21 , 23 , 25 , 29 , 30 1 on both trauma and emergency general surgery 20 and 2 on burn surgery. 18 , 27 For emergency general surgery, 3 studies described conditions, 13 , 16 , 20 with only 1 comparing postoperative outcomes to nonincarcerated individuals (Supplemental Table 3, http://links.lww.com/AOSO/A345 ).…”

“…However, functional outcomes were clinically worse with high rates of prolonged immobilization (14% vs 5%) and stiffness (58% vs 48%) after repair. 29 , 30 Among incarcerated individuals with scaphoid fractures (n = 13), surgery was performed in 50% of cases, and half of these cases were complicated by nonunion. 15 …”

Functional Hand-Based Splint in the Treatment of Metacarpal Fractures

“…Despite this, the most common complication following the acute management of metacarpal fractures is stiffness. 18,19 Therefore, hand surgeons should be trying to reduce the extent and duration of immobilization so as to prevent soft tissue tightening while maintaining bony reduction.…”