Abstract
Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. A comprehensive search was conducted across multiple databases, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1600 records were identified; 7 studies fulfilled eligibility criteria and were included. No randomized controlled trials directly comparing surgery with nonsurgical treatment were found. One retrospective study compared nonsurgical with surgical treatment, whereas 6 compared surgical or nonsurgical treatments. Considerable heterogeneity between studies along with a high or critical risk of bias restricts direct comparison and conclusions. There is a lack of high-quality evidence to guide treatment, supporting the need for well-designed, multicenter trials to identify the most effective and cost-efficient treatment for metacarpal shaft fractures in adults.
Highlights
Metacarpal shaft fractures (MSF) are common injuries, accounting for 10-31% of all hand fractures.[1,2,3,4,5,6] They place a significant burden on healthcare resources and society, commonly affecting young economically active patients.Despite their prevalence, acceptable parameters of deformity vary widely in the literature 7-9 and there is no consensus on the best practice management approach
We report the findings of a systematic review of the treatment of MSF
We developed a protocol in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement 12 and prospectively registered the review on
Summary
Metacarpal shaft fractures (MSF) are common injuries, accounting for 10-31% of all hand fractures.[1,2,3,4,5,6] They place a significant burden on healthcare resources and society, commonly affecting young economically active patients. Despite their prevalence, acceptable parameters of deformity vary widely in the literature 7-9 and there is no consensus on the best practice management approach. Surgical techniques include Kirchner wires (K-wires) fixation, intraosseous wires, interfragmentary compression screws, plates or external fixators Both non-surgical and surgical treatment require significant resources and a period of rehabilitation of weeks to months, during which use of the hand is restricted. Surgical treatment is perceived to be more costly due to the need for specialist resources, additional equipment and theatre use
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