Conservative Treatment for Closed Fifth Metacarpal Neck Fractures
There is no evidence of the superiority of any single non-operative treatment regimen for fracture of the neck of the fifth metacarpal. Level of evidence: "D"A Cochrane review [Abstract] 1 included five studies with a total of 252 subjects. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior.
The treatment options used in the included trials were:
- splinting with ulnar gutter splint for three weeks compared to immediate mobilization in a "bulky dressing" (compression bandage)
- ulnar gutter plaster cast for a period of three weeks followed by mobilization compared to a "pressure bandage" (compression bandage) or one week and immediate mobilization within limits imposed by pain
- ulnar gutter cast with the wrist in 45 degrees dorsiflexion, the MCP joints in 90 degrees flexion and the IP joints in 0 to 10 degrees flexion compared to functional taping (also known as neighbour strapping)
- metacarpal brace compared to neighbour strapping (also known as functional taping)
- reduction of fracture and splinting with the MCP joints in 60 degrees flexion for four weeks compared to an elastic bandage 5 cm wide with slight compression (compression bandage).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in interventions and outcomes), and by indirectness (validated patient outcome scores not used and short follow-up times).
References
- Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005;(3):CD003210 [Last assessed as up-to-date: 3 August 2008]. [PubMed]