Fifth Metacarpal Neck Fractures in the United States: Trends in Current Management

Abstract

Objectives Management of fifth metacarpal neck fractures lacks consensus and is highly variable. Our study aims to examine patterns and trends in nonoperative treatment, surgical indications, and surgical techniques for fifth metacarpal neck fractures amongst hand surgeons of different demographic backgrounds within the United States of America. Methods A survey of 18 questions was hosted online and distributed to the American Society for Surgery of the Hand (ASSH) members via email. Questions sought to determine the demographics of the surgeon, the preferred treatment for metacarpal fractures of varying degrees of angulation, immobilization technique, factors leading to surgical intervention, and preferred surgical intervention. Responses were analyzed for significant patterns and trends. Results A total of 581 responses were received (17% response rate). Most respondents utilize intramedullary lines on lateral radiographs to measure fracture angulation, prefer splinting in the intrinsic-plus position, and prefer closed reduction and percutaneous pinning for surgical management. Average measurements indicating patients for surgery were 9.2⁰ of rotation, 41.6⁰ of sagittal malalignment, 20.2⁰ of coronal malalignment, or 6.1 mm of shortening. On average, orthopaedic surgeons tolerated greater degrees of volar angulation (43.8⁰) than general surgeons (30.7⁰) or plastic surgeons (27.9⁰). Conclusions Our study reveals several significant differences regarding managing fifth metacarpal neck fractures between hand surgeons with different residency backgrounds, variable years of experience, and different practice settings. The geographic region of practice and primary consultant were less impactful. Ultimately, management decisions appear to be a result of patient-specific factors as well as surgeon preference.