Fifth Metacarpal Neck Fractures: Less Is More

Fifth metacarpal neck fractures are common injuries of the hand. There is a lack of consensus regarding the optimal treatment for these injuries, with a variety of treatment modalities available. We provide an updated literature review of randomized controlled trials comparing clinical and functional outcomes of operative versus nonoperative management of these injuries.

A literature search in the PubMed/MEDLINE database was conducted. Inclusion criteria were as follows: (1) the study was a primary study written in English, (2) the study compared treatment options for fifth metacarpal neck fractures, and (3) the study was a randomized controlled trial. Relevant studies were then reviewed in entirety, and the results were tabulated for further comparison.

Thirteen studies were identified and included for analysis. Operative management does not seem to offer a significant improvement in long-term outcomes. The majority of included studies compared nonoperative management approaches, ranging from buddy taping to more restrictive immobilization such as forearm-based ulnar gutter splints. In general, these studies demonstrate comparable outcomes with respect to pain, range of motion, and patient satisfaction. When operative management is pursued, intramedullary nailing may result in superior outcomes relative to transverse pinning.

Many fifth metacarpal neck fractures can be successfully treated nonoperatively. Among nonoperative management options, nonoperative approaches seem to yield comparable results to more restrictive immobilization options. A thorough understanding of a patient's goals and expectations can help guide physicians and patients in selecting the best management option.