Fractures at the Base of the Fifth Metacarpal: Epidemiology and Radiograchic Features
William K Snapp, MD; Geoffrey Hogan, BS; Adnan Prsic, MD; Jonathan Bass, MD; Scott Schmidt, MD; Reena A Bhatt, MD
Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI
Introduction: Fractures of the metacarpals encompass 18-44% of all hand fractures1. The 5th metacarpal is the most commonly fractured metacarpal, and fracture of the base is second only to metacarpal neck fractures2. Despite the relatively common occurrence of this fracture, there is a paucity of evidence in the literature regarding patterns of injury and optimal treatment for fracture of the base of the 5th metacarpal3,4. This study aims to evaluate the incidence, distribution, mechanism of injury and treatment of fractures of the base of the 5thmetacarpal, to further improve the management of such injuries.
Materials and Methods: A retrospective chart review was performed of 74 patients with fractures at the base of the 5th metacarpal seen within a 5 year period (2011-2016). Patient demographics, mechanism of injury, intra- versus extra-articular, comminution, displacement, non-operative and operative treatment, time to surgery and follow-up time were collected. Fracture patterns were analyzed using Pearson's Chi-Squared Test to determine whether each variable influences operative vs. non-operative management.
Results: Most common mechanism of injury was punch (41.9%), fall (29.7%), and MVC (17.6%). 71.6% of patients were male and 28.4% were female. Average follow-up time was 35.19 ± 56.86 days, and 39.1% of patients lost to follow-up. Of the fractures, 17.7% were fully displaced, 44.6% were minimally displaced and 29.7% were non-displaced. 64.9% were intra-articular fractures and 43.1% were comminuted fractures. 18.9% of patients underwent operative treatment. Intra-articular fractures of the 5th metacarpal were significantly more likely to require operative management than extra-articular fractures, p=0.015. Similarly, fully displaced fractures required operative treatment significantly more often than minimally displaced or nondisplaced fractures, p=0.047. Comminution had no significant effect on whether a fracture was managed operatively or non-operatively, p=0.57.
Conclusions: Although fractures of the base of the fifth metacarpal occur relatively frequently, there is no consensus for appropriate treatment. This study demonstrates that these fractures occur in a wide variety of patterns, and that particular features may increase the need for operative management. Articular involvement and fracture displacement had a significant effect on the decision to operate, while fracture comminution did not. Unfortunately, functional outcomes were limited due to poor patient follow-up. Further studies are needed to explore outcomes after operative and non-operative management of the various patterns of fracture at the base of the fifth metacarpal.
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