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PURPOSE: To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED). METHODS: We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only. RESULTS: There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery. CONCLUSIONS: Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
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Introduction: Isolated palmar carpometacarpal dislocation of the small finger is infrequent, this injury often goes unnoticed in the evaluation at the emergency room, for which physical evaluation and X-ray findings can avoid missing this diagnosis. We describe a case report and propose a treatment algorithm for isolated dislocations of the carpometacarpal joint of the fifth finger to the palmar that is not diagnosed and treated early, using this algorithm, the surgeon will have a vision of the probable best treatment option. Case Presentation: A 50-year-old with late presentation of palmar dislocation of the fifth metacarpal bone, the diagnosis that went unnoticed in the initial emergency assessment. The patient was taken to an open reduction and internal fixation with an internal brace fixed at the base of the fifth metacarpal, the base of the fourth metacarpal and the hamate, and the fifth metacarpal was fixed to the fourth metacarpal with a Kirschner wire placed transversely to the axis of the metacarpal. Conclusion: Physical evaluation and X-ray findings, physicians can avoid missing isolated palmar carpometacarpal dislocation of the small finger. Using this algorithm according to the temporality of the injury, direction of the dislocation, and stability of the joint, the surgeon will have a vision of the probable best treatment option.
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PURPOSE: To assess whether or not attempted closed reduction of fifth metacarpal neck fractures results in decreased fracture angulation at final follow-up. METHODS: Retrospective chart review of all patients aged 18 and older managed for isolated fifth metacarpal neck fractures between 2004 and 2014. RESULTS: Sixty-six patients managed for an isolated boxer fracture met inclusion criteria. Twenty-three patients underwent attempted reduction and 43 patients did not. Patients undergoing attempted reduction had a statistically significant improvement in fracture angulation following reduction compared with patients not undergoing attempted reduction. At final follow-up, there was no difference in fracture angle between the 2 groups. CONCLUSIONS: Closed reduction and splint immobilization of fifth metacarpal neck fractures was not an effective means of maintaining a significant improvement in fracture alignment upon healing. Other means, such as closed reduction with pin fixation or open reduction internal fixation, should be considered when maintenance of reduction is desired. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.