Management of metacarpal shaft fractures: a survey of current UK practice.

Abstract

Metacarpal shaft fractures (MSF) are common injuries that predominantly affect young, economically active people. However, there is limited evidence to guide their management. The aims of this study were to: evaluate the management of extra-articular MSF of the fingers; assess equipoise for surgical and nonsurgical treatments; and explore factors influencing clinician decision making to inform the design of a randomised controlled trial (RCT) comparing surgical and nonsurgical treatments. A cross-sectional, web-based survey was distributed to UK hand surgeons using membership directories of different professional networks. Practice setting, clinical experience, management strategies, willingness to participate in a RCT and factors affecting suitability for randomisation were recorded. There were 108 responses eligible for analysis. Distribution of clinical experience ranged from <5 to >20 years. A variety of treatments were used for transverse, long oblique/spiral and comminuted MSF. Rotational deformity (90%), step-off deformity (5%) and angulation (5%) were the most important indications for surgical fixation. Acceptable limits of fracture angulation and shortening varied among surgeons. Over 85% expressed interest in participating in a RCT and most showed equipoise and were willing to offer operative or nonoperative treatment as part of a research study. This survey demonstrates that UK hand surgeons have varying views on treatments, acceptable parameters of deformity and indications for surgical fixation of displaced MSF. There is equipoise for surgical and nonsurgical treatments, variability in factors influencing clinical decision making and support for RCTs to investigate best practice.