A comparative study to assess the effect of conservative versus operative management on functional outcome in patients with metacarpal fractures

Abstract

Aims and Objectives: The primary objective of this study is to evaluate and assess healing, functional outcomes and complications of conservatively versus operatively managed metacarpal fractures. Materials: Our study was conducted in a total of 50 patients with sixty-eight metacarpal fractures of the hand in patients aged 18 to 65 years conducted during the period of 2016 to 2018. Unstable metacarpal fractures, intra- articular fractures, avulsion fractures were included in this study. Fracture dislocations, open fractures with severe soft tissue injury, tendon injury, neurovascular injury and pathological fractures were excluded. Primary outcomes were assessed using the Quick DASH score and Michigan Hand QuestionnaireResults and Observations: Out of 50 patients, 72% were males and 28% females with the male to female ratio being almost 2.5:1. Almost 80% of patients fell in the category of 20-40 years. The 3rd and 5th metacarpal fractures were the most common, having an incidence of 20.6% and 32.4% respectively. The average time taken to union in study was approximately 6.5 weeks with age being more of a factor than treatment protocol as both conservatively managed and operatively managed fractures began to show union as early as 3 weeks. According to the study, 5 complications were found, with stiffness and superficial infection being the most common.Conclusion: Functional outcome is of paramount importance and restoration to maximum hand function and is the primary expectation of the patient. Conservative management and operative management, both have their merits and demerits and should be chosen as per surgeon experience, preference and patient expectation. Physical therapy and mobilization are key in managing these fractures and should not be neglected and should rather form an integral path to recovery.