Conservative treatment for closed fifth (small finger) metacarpal neck fractures

Abstract

Background: Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement. Objectives: To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (June 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to May Week 3 2008), EMBASE (1988 to 2008, Week 22), and reference lists of articles. No language restrictions were applied. Selection criteria: All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures. Data collection and analysis: Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data. Main results: Five studies met the inclusion criteria including a total of 252 participants. 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. Authors' conclusions: No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. Consequently, no single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another. Further research is definitely warranted.