Metacarpal Fracture Trends in Treatment: A Matched Cohort Analysis of 1022 Patients

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Rothman Orthopaedic Institute

2 Rothman Orthopaedics; Thomas Jefferson University

3 Rothman Orthopaedic Institute Department of Orthopaedic Surgery Philadelphia, Pennsylvania

4 Sidney Kimmel Medical College at Thomas Jefferson University

5 Rothman Institute at the Thomas Jefferson University, Philadelphia, PA

6 Thomas Jefferson University

10.22038/abjs.2025.80704.3683

Abstract

Objectives

The goals of this study were twofold: first, to assess epidemiologic characteristics of metacarpal fractures including patient and fracture characteristics. Second, to investigate the most common treatment strategies employed.

Methods

Patients presenting to a single large academic practice with isolated acute metacarpal fractures were retrospectively reviewed. Baseline demographics and fracture-specific data were collected. Two investigative arms of the study were then delineated; first, patient groups were matched based on metacarpal involvement between operative and nonoperative cohorts. Second, CPT-stratified data was independently assessed and grouped based on frequency. A secondary, non-matched analysis was performed to assess management strategies and the relative frequency of varying techniques.

Results

After matching, 1022 patients were included in the first investigational arm. Fractures of the fifth metacarpal were most common. Most operative fractures were located at the metacarpal shaft (43.2%), whereas those managed nonoperatively were mostly found at the metacarpal neck (38.2%). In the second investigational arm, the four most common CPT codes were 26600 (closed management without manipulation), 26615 (open reduction and internal fixation), 26608 (closed reduction and percutaneous pinning), and 26605 (closed management with manipulation) in descending order. 97.2% of patients undergoing ORIF underwent plate and screw fixation.

Conclusion

Most metacarpal fractures were found to have been managed nonoperatively. When treated operatively, metacarpal fractures were more often treated with open reduction and internal fixation rather than closed reduction and pinning. Most patients were treated with a plate and screw construct in favor of an intramedullary screw.

Keywords: Metacarpal; treatment trends; fracture fixation; metacarpal repair

Level of Evidence: 2b

Keywords

Main Subjects

The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 04 May 2025

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History

  • Receive Date: 16 November 2024
  • Revise Date: 11 January 2025
  • Accept Date: 13 January 2025

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