Ponce, B, Complications of Metacarpal Fracture Fixation

Introduction: Metacarpal fractures are among the most common fractures of the upper extremity mostly affecting a population ranging from 18-34 years old with a male predominance (76%), accounting for 30-50% of all hand fractures. Although many extra-articular metacarpal fractures can be managed nonoperatively with cast immobilization, surgical intervention has been recommended for closed fractures based on the fracture’s degree of malrotation, shortening and angulation. The indications are based on historical literature and expert opinion. The goal of this study is to further refine those indications by evaluating functional outcome scores and complications seen after operatively versus non-operatively managed extraarticular metacarpal shaft fractures. The hypothesis is that non-operatively managed metacarpal fractures that meet historical operative criteria will have a similar functional outcome as operatively managed fractures with a lower complication rate. Methods: An electronic search of the medical records was performed to retrospectively identify patients based on CPT and ICD codes with extra-articular metacarpal fractures involving the index through small fingers that were treated by orthopedics or plastic surgery between the years 2015 and 2019. Patients with fractures greater than 3 weeks old, intra-articular fractures, open fractures, concomitant hand injuries, patients under the age of 18, and thumb metacarpal fractures were excluded. The remaining patients’ charts were reviewed to determine the treatment pursued and to look for any complications during the follow up period. Demographic data including hand dominance, smoking status, psychiatric history, treatment duration, number of injured metacarpals, and affected digit were also recorded. Radiographs were reviewed to determine degree of angulation and amount of shortening. Approximately 200 adult patients were included. Patients that are one year from date of injury will be contacted and functional outcome scores will be measured using two validated functional outcome score surveys - PROMISE and PRWHE. Statistical analysis will be used to determine any statistically significant difference in outcome scores or complications between the non-operatively and operatively treated groups. Results: 131 patients with an average follow up of 5.5 weeks have been retrospectively identified as eligible prior to prospective data collection. At this time the average age was 37.4 years with slightly more males than females (56%). The dominant hand was injured with a frequency of 72% with the predominant mechanism of injury being punching (39%). Single metacarpal fractures were more common than multiple (86%) with the small finger most commonly affected (57%). Transverse fractures were most prevalent (34%). Nonoperative treatment (splint, cast) was pursued 94% of the time. Complications were reported at 22% with extensor lag being the most common. Conclusion: Next steps involve collection of prospective data on this growing retrospectively evaluated pool of patients and more retrospective evaluation of the smaller operatively managed group. Descriptive statistics will then be used to analyze our sample population to assess for differences across variables related to the presence or absence of surgical intervention. This will help guide surgical indications to minimize negative sequelae of unnecessary operation for what comprises a large percentage of hand fractures. Contact info: Brandon Ponce poncerb@mail.uc.edu (805) 501-9412 Key Words: metacarpal shaft, outcomes, nonoperative, closed reduction, extraarticular, complications